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https://www.readbyqxmd.com/read/28631455/the-prognostic-importance-of-chronic-end-stage-diseases-in-geriatric-patients-admitted-to-163-italian-icus
#1
Daniele Poole, Stefano Finazzi, Giovanni Nattino, Danilo Radrizzani, Giuseppe Gristina, Paolo Malacarne, Sergio Livigni, Guido Bertolini
BACKGROUND: The number of elderly patients undergoing major surgical interventions and then needing admission to intensive care unit (ICU) grows steadily. We investigated this issue in a cohort of 232,278 patients admitted in 5 years (2011-2015) to 163 Italian general ICUs. METHODS: Surgical patients older than 75 registered in the GiViTI MargheritaPROSAFE project were analysed. The impact on hospital mortality of important chronic conditions (severe COPD, NYHA class IV, dementia, end-stage renal disease, cirrhosis with portal hypertension) was investigated with two prognostic models developed yearly on patients staying in the ICU less or more than 24 hours...
June 14, 2017: Minerva Anestesiologica
https://www.readbyqxmd.com/read/28627291/early-complications-morbidity-and-mortality-in-octo-and-nonagenarians-undergoing-posterior-intraoperative-spinal-navigation-based-c1-2-fusion-for-type-ii-odontoid-process-fractures
#2
Basem Ishak, Till Schneider, Valerie Gimmy, Andreas W Unterberg, Karl L Kiening
Type II odontoid fractures represent the most common cervical spine injury in the elderly. The decision for surgical treatment is still controversial, particularly with regard to the elevated perioperative risk attributed to frequent comorbidities and poor bone quality. Purpose of this study was to assess both short-term mortality and mid-term clinical and radiological outcome in the elderly. Between January 2007 and December 2015, 35 patients with type II odontoid process fractures who underwent posterior atlanto-axial instrumentation using a modified Goel-Harms technique were retrospectively analyzed and prospectively examined clinically and radiologically...
June 18, 2017: Journal of Neurotrauma
https://www.readbyqxmd.com/read/28625194/preoperative-malnutrition-is-associated-with-increased-mortality-and-adverse-outcomes-after-paediatric-cardiac-surgery
#3
Faith Ross, Gregory Latham, Denise Joffe, Michael Richards, Jeremy Geiduschek, Michael Eisses, Douglas Thompson, Monique Radman
BACKGROUND: Malnutrition is common in children with CHD and is likely to place them at an increased risk for adverse surgical outcomes. We sought to evaluate the impact of preoperative malnutrition on outcomes after paediatric cardiac surgery. METHODS: We conducted a retrospective analysis of patients from age 0 to 5 years undergoing cardiac surgery at Seattle Children's Hospital from 2006 to 2015. We used regression modelling to examine the impact of malnutrition on surgical outcomes...
June 19, 2017: Cardiology in the Young
https://www.readbyqxmd.com/read/28624864/the-clinical-significance-of-pneumonia-in-patients-with-respiratory-specimens-harbouring-multidrug-resistant-pseudomonas-aeruginosa-a-5-year-retrospective-study-following-5667-patients-in-four-general-icus
#4
B Borgatta, S Gattarello, C A Mazo, A T Imbiscuso, M N Larrosa, M Lujàn, J Rello
Pseudomonas aeruginosa is the leading cause of pneumonia in intensive care units (ICUs), with multidrug-resistant (MDR) strains posing a serious threat. The aim of this study was to assess the clinical relevance of MDR Pseudomonas isolates in respiratory clinical specimens. A 5-year retrospective observational study in four medical-surgical ICUs from a referral hospital was carried out. Of 5667 adults admitted to the ICU, 69 had MDR-PA in respiratory samples: 31 were identified as having pneumonia (HAP/VAP): 21 ventilator-associated pneumonia (VAP) and ten hospital-acquired pneumonia (HAP)...
June 17, 2017: European Journal of Clinical Microbiology & Infectious Diseases
https://www.readbyqxmd.com/read/28622004/six-month-morbidity-and-mortality-among-icu-patients-receiving-life-sustaining-therapy-a-prospective-cohort-study
#5
Michael E Detsky, Michael O Harhay, Dominique F Bayard, Aaron M Delman, Anna E Buehler, Saida A Kent, Isabella V Ciuffetelli, Elizabeth Cooney, Nicole B Gabler, Sarah J Ratcliffe, Mark E Mikkelsen, Scott D Halpern
RATIONALE: Understanding long-term outcomes of critically ill patients may inform shared decision making in the ICU. OBJECTIVE: To quantify six-month functional outcomes of general ICU patients, and develop a multivariable model comprising factors present during the first ICU day to predict which patients will return to their baseline function 6 months later. METHODS: We conducted a prospective cohort study in three medical ICUs and two surgical ICUs in three hospitals...
June 16, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28618727/analysis-of-epidemiology-and-risk-factors-for-mortality-in-ventilator-associated-pneumonia-attacks-in-intensive-care-unit-patients
#6
Ayşe But, Meltem Arzu Yetkin, Dilek Kanyilmaz, Halide Aslaner, Aliye Baştuğ, Adalet Aypak, Pınar Öngürü, Esragül Akinci, Nevzat Mehmet Mutlu, Hürrem Bodur
BACKGROUND/AIM: The aim of this study was to investigate the epidemiologic characteristics, the causative microorganisms and their antimicrobial susceptibility patterns, and the prognostic risk factors for mortality in critically ill patients with ventilator-associated pneumonia (VAP). MATERIALS AND METHODS: In this retrospective observational study, all the critically ill patients with VAP hospitalized in a medical/surgical intensive care unit (ICU) between January 2010 and June 2015 were evaluated...
June 12, 2017: Turkish Journal of Medical Sciences
https://www.readbyqxmd.com/read/28618123/-pain-relieved-but-still-struggling-critically-ill-patients-experiences-of-pain-and-other-discomforts-during-analgosedation
#7
Helene Berntzen, Ida Torunn Bjørk, Hilde Wøien
AIM & OBJECTIVE: To explore how critically ill patients treated according to a strategy of analgosedation experience and handle pain, other discomforts, and wakefulness. BACKGROUND: Patients experience both pain and discomfort while in the intensive care unit (ICU). International guidelines recommend focused pain treatment and light sedation. An analgosedation protocol favoring pain management, light sedation and early mobilization was implemented in our university hospital medical and surgical ICU in Norway in 2014...
June 15, 2017: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/28616369/management-of-an-obstructed-tracheostomy-in-a-limited-resource-setting
#8
Julie Chiaravalli, Norman Lufesi, Elwin Shawa, Vitumbiko Nkhoma, Elaine Sigalet, Adam Dubrowski
Obstruction of a tracheostomy tube is a common cause of respiratory compromise in adults and pediatric patients, which can lead to a life-threatening emergency if it is not properly managed. Compromised airway patency has many potential etiologies; however, the scenario described in this technical report focuses specifically on the management of tracheostomy obstruction through the presence of a mucus plug, blood clot, or highly viscous secretions. The simulation described in this technical report was written to be conducted as an in-situ simulation within the intensive care unit (ICU) at Mzuzu Central Hospital, Malawi...
May 13, 2017: Curēus
https://www.readbyqxmd.com/read/28616291/intensive-blood-pressure-control-in-patients-with-acute-type-b-aortic-dissection-raid-study-protocol-for-randomized-controlled-trial
#9
REVIEW
Jian-Cang Zhou, Nan Zhang, Zhong-Heng Zhang, Ting-Ting Wang, Yue-Feng Zhu, Hui Kang, Wei-Min Zhang, Dong-Lin Li, Wei-Dong Li, Zhen-Jie Liu, Xi-Min Qian, Ming-You Zhang, Jue Wang, Mi Zhou, Zhi-Tao Yang, Yun-Xian Yu, Hang-Yang Li, Jian Zhang, Yong-Gang Wang, Jian-Ping Gao, Lin Ling, Kong-Han Pan
BACKGROUND: Blood pressure control is an essential therapy for patients with acute type B aortic dissection (ABAD) and should be maintained throughout the entire treatment. Thus, vast majority current guidelines recommend control the blood pressure to lower than 140/90 mmHg. Theoretically, a much lower target may further decrease the risk of propagation of dissection. However, some argued that too lower blood pressure would compromise the organ perfusion. Thus, there is no unanimous optimal target for blood pressure in patients with ABAD so far...
May 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28616212/hypophosphatemia-in-critically-ill-patients-with-acute-kidney-injury-treated-with-hemodialysis-is-associated-with-adverse-events
#10
Cynthia Lim, Han Khim Tan, Manish Kaushik
Background. Hypophosphatemia in critically ill patients may be exacerbated by renal replacement therapy (RRT). We aimed to identify risk factors and adverse outcomes associated with hypophosphatemia in intensive care patients treated with RRT for acute kidney injury (AKI). Methods. This was a secondary analysis of data from a single-center prospective cohort study of medical and surgical intensive care patients with RRT for AKI between 18 December 2010 and 3 April 2013. Demographic, comorbidity, laboratory and RRT data were retrieved from patient case notes and electronic medical records...
June 2017: Clinical Kidney Journal
https://www.readbyqxmd.com/read/28613991/microbial-characteristics-of-nosocomial-infections-and-their-association-with-the-utilization-of-hand-hygiene-products-a-hospital-wide-analysis-of-78-344-cases
#11
Song Liu, Meng Wang, Gefei Wang, Xiuwen Wu, Wenxian Guan, Jianan Ren
BACKGROUND: Nosocomial infections are the main adverse events during health care delivery. Hand hygiene is the fundamental strategy for the prevention of nosocomial infections. Microbial characteristics of nosocomial infections in the Asia-Pacific region have not been investigated fully. Correlation between the use of hand hygiene products and the incidence of nosocomial infections is still unknown. This study investigates the microbial characteristics of nosocomial infections in the Asia-Pacific region and analyzes the association between the utilization of hand hygiene products and the incidence of nosocomial infections...
June 14, 2017: Surgical Infections
https://www.readbyqxmd.com/read/28611229/variation-in-definition-of-prolonged-mechanical-ventilation
#12
Louise Rose, Michael McGinlay, Reshma Amin, Karen Ea Burns, Bronwen Connolly, Nicholas Hart, Philippe Jouvet, Sherri Katz, David Leasa, Cathy Mawdsley, Danny F McAuley, Marcus J Schultz, Bronagh Blackwood
Consistency of definitional criteria for terminology applied to describe subject cohorts receiving mechanical ventilation within ICU and post-acute care settings is important for understanding prevalence, risk stratification, effectiveness of interventions, and projections for resource allocation. Our objective was to quantify the application and definition of terms for prolonged mechanical ventilation. We conducted a scoping review of studies (all designs except single-case study) reporting a study population (adult and pediatric) using the term prolonged mechanical ventilation or a synonym...
June 13, 2017: Respiratory Care
https://www.readbyqxmd.com/read/28610936/safety-of-early-ambulation-following-blunt-abdominal-solid-organ-injury-a-prospective-observational-study
#13
Eugene Wang, Kenji Inaba, Saskya Byerly, Ranan Mendelsberg, Jack Sava, Elizabeth Benjamin, Lydia Lam, Demetrios Demetriades
BACKGROUND: There is continued debate regarding the optimal period of bed-rest and in-hospital monitoring for non-operative management of solid organ injury following blunt trauma. METHODS: Single center, prospective, observational study of blunt solid organ injuries from 07/2014-02/2016, managed initially without surgical or angiographic intervention. Early ambulation was defined as ≤24 h. RESULTS: 79 patients met inclusion criteria, with 36 (45...
June 6, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28610934/boarding-icu-patients-are-our-rounding-practices-subpar
#14
Andrew M Nunn, Justin S Hatchimonji, Daniel N Holena, Mark J Seamon, Brian P Smith, Lewis J Kaplan, Niels D Martin, Patrick M Reilly, C William Schwab, Jose L Pascual
INTRODUCTION: Surgical Intensive Care Unit (SICU) patients "boarding" in ICUs other than the designated home unit have been shown to suffer increased rates of complications. We hypothesized that ICU rounding practices are different when SICU patients are housed in home vs. boarding ICUs. MATERIAL AND METHODS: SICU rounds were observed at an academic quaternary medical center. Individual patient rounding time and order seen on rounds along with patient data and demographics were recorded...
June 10, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28608513/out-of-office-hours-elective-surgical-intensive-care-admissions-and-their-associated-complications
#15
David J R Morgan, Kwok Ming Ho, Yang Jian Ong, Marlene L Kolybaba
BACKGROUND: The 'weekend' effect is a controversial theory that links reduced staffing levels, staffing seniority and supportive services at hospitals during 'out-of-office hours' time periods with worsening patient outcomes. It is uncertain whether admitting elective surgery patients to intensive care units (ICU) during 'out-of-office hours' time periods mitigates this affect through higher staffing ratios and seniority. METHODS: Over a 3-year period in Western Australia's largest private hospital, this retrospective nested-cohort study compared all elective surgical patients admitted to the ICU based on whether their admission occurred 'in-office hours' (Monday-Friday 08...
June 12, 2017: ANZ Journal of Surgery
https://www.readbyqxmd.com/read/28608135/can-proportional-ventilation-modes-facilitate-exercise-in-critically-ill-patients-a-physiological-cross-over-study-pressure-support-versus-proportional-ventilation-during-lower-limb-exercise-in-ventilated-critically-ill-patients
#16
Evangelia Akoumianaki, Nicolas Dousse, Aissam Lyazidi, Jean-Claude Lefebvre, Severine Graf, Ricardo Luiz Cordioli, Nathalie Rey, Jean-Christophe Marie Richard, Laurent Brochard
BACKGROUND: Early exercise of critically ill patients may have beneficial effects on muscle strength, mass and systemic inflammation. During pressure support ventilation (PSV), a mismatch between demand and assist could increase work of breathing and limit exercise. A better exercise tolerance is possible with a proportional mode of ventilation (Proportional Assist Ventilation, PAV+ and Neurally Adjusted Ventilatory Assist, NAVA). We examined whether, in critically ill patients, PSV and proportional ventilation have different effects on respiratory muscles unloading and work efficiency during exercise...
December 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/28607286/morbidity-analysis-in-minimally-invasive-esophagectomy-for-oesophageal-cancer-versus-conventional-over-the-last-10-years-a-single-institution-experience
#17
Misbah Khan, Muhammad Ijaz Ashraf, Aamir Ali Syed, Shahid Khattak, Namra Urooj, Anam Muzaffar
BACKGROUND: There has been an increasing inclination towards minimally invasive esophagectomies (MIEs) at our institute recently for resectable oesophageal cancer. OBJECTIVES: The purpose of the present study is to report peri-operative and long-term procedure specific outcomes of the two groups and analyse their changing pattern at our institute. METHODS: All adult patients with a diagnosis of oesophageal cancer managed at our institute from 2005 to 2015 were included in this retrospective study...
July 2017: Journal of Minimal Access Surgery
https://www.readbyqxmd.com/read/28605922/surgical-coronary-revascularization-on-pump-versus-off-pump-in-patients-with-stenosis-of-the-main-tree-of-the-left-coronary-artery-and-carotid-stenosis
#18
Edin Kabil, Bedrudin Banjanović, Emir Mujanović
OBJECTIVE: The aim of this study was to show perioperative complications of CABG procedure with and without cardiopulmonary bypass (CPB) in patients with combined coronary and carotid disease. PATIENTS AND METHODS: This retrospective survey included patients with left main stenosis greater than 50% and carotid stenosis over 50%, who had undergone CABG without carotid endarterectomy at the BH Heart Centre, from May 2009 to May 2014. The patients were divided into two groups according to the surgical method used...
May 2017: Acta Medica Academica
https://www.readbyqxmd.com/read/28601795/the-role-of-nurses-clinical-impression-in-the-first-assessment-of-children-at-the-emergency-department
#19
Joany M Zachariasse, Dominique van der Lee, Nienke Seiger, Evelien de Vos-Kerkhof, Rianne Oostenbrink, Henriëtte A Moll
OBJECTIVE: To assess the diagnostic value and determinants of nurses' clinical impression for the recognition of children with a serious illness on presentation to the emergency department (ED). DESIGN: Secondary analysis of a prospective cohort. SETTING AND PATIENTS: 6390 consecutive children <16 years of age presenting to a paediatric ED with a non-surgical chief complaint and complete data available. MAIN OUTCOME MEASURES: Diagnostic accuracy of nurses' clinical impression for the prediction of serious illness, defined by intensive care unit (ICU) and hospital admission...
June 10, 2017: Archives of Disease in Childhood
https://www.readbyqxmd.com/read/28599676/a-randomized-trial-of-supplemental-parenteral-nutrition-in-underweight-and-overweight-critically-ill-patients-the-top-up-pilot-trial
#20
Paul E Wischmeyer, Michel Hasselmann, Christine Kummerlen, Rosemary Kozar, Demetrios James Kutsogiannis, Constantine J Karvellas, Beth Besecker, David K Evans, Jean-Charles Preiser, Leah Gramlich, Khursheed Jeejeebhoy, Rupinder Dhaliwal, Xuran Jiang, Andrew G Day, Daren K Heyland
BACKGROUND: Nutrition guidelines recommendations differ on the use of parenteral nutrition (PN), and existing clinical trial data are inconclusive. Our recent observational data show that amounts of energy/protein received early in the intensive care unit (ICU) affect patient mortality, particularly for inadequate nutrition intake in patients with body mass indices (BMIs) of <25 or >35. Thus, we hypothesized increased nutrition delivery via supplemental PN (SPN) + enteral nutrition (EN) to underweight and obese ICU patients would improve 60-day survival and quality of life (QoL) versus usual care (EN alone)...
June 9, 2017: Critical Care: the Official Journal of the Critical Care Forum
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