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Emergency intensive critical care

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https://www.readbyqxmd.com/read/28222811/recurring-septic-shock-in-a-patient-with-blunt-abdominal-and-pelvic-trauma-how-mandatory-is-source-control-surgery-a-case-report
#1
Antonella Frattari, Giustino Parruti, Rocco Erasmo, Luigi Guerra, Ennio Polilli, Rosamaria Zocaro, Giuliano Iervese, Paolo Fazii, Tullio Spina
BACKGROUND: In critically ill patients with colonization/infection of multidrug-resistant organisms, source control surgery is one of the major determinants of clinical success. In more complex cases, the use of different tools for sepsis management may allow survival until complete source control. CASE PRESENTATION: A 42-year-old white man presented with traumatic hemorrhagic shock. Unstable pelvic fractures led to emergency stabilization surgery. Fever ensued with diarrhea, followed by septic shock...
February 22, 2017: Journal of Medical Case Reports
https://www.readbyqxmd.com/read/28213888/transfusion-in-critical-care-a-uk-regional-audit-of-current-practice
#2
J O M Plumb, M G Taylor, E Clissold, M P W Grocott, R Gill
A consistent message within critical care publications has been that a restrictive transfusion strategy is non-inferior, and possibly superior, to a liberal strategy for stable, non-bleeding critically ill patients. Translation into clinical practice has, however, been slow. Here, we describe the degree of adherence to UK best practice guidelines in a regional network of nine intensive care units within Wessex. All transfusions given during a 2-month period were included (n = 444). Those given for active bleeding or within 24 h of major surgery, trauma or gastrointestinal bleeding were excluded (n = 148)...
February 18, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28191345/holistic-care-for-patients-during-weaning-from-mechanical-ventilation-a-qualitative-study
#3
Ali Khalafi, Nasrin Elahi, Fazlollah Ahmadi
BACKGROUND: Weaning patients from mechanical ventilation is a complex and highly challenging process. It requires continuity of care, the overall assessment of patients, and a focus on all aspects of patients' needs by critical care nurses. OBJECTIVES: The aim of the present study was to explore holistic care while patients are being weaned from mechanical ventilation from the perspective of the critical care nurses. METHODS: The study was carried out in the intensive care units (ICUs) of six hospitals in Ahvaz, Iran, from 2014 to 2015...
November 2016: Iranian Red Crescent Medical Journal
https://www.readbyqxmd.com/read/28187802/critical-care-management-of-traumatic-brain-injury
#4
D K Menon, A Ercole
Traumatic brain injury (TBI) is a growing global problem, which is responsible for a substantial burden of disability and death, and which generates substantial healthcare costs. High-quality intensive care can save lives and improve the quality of outcome. TBI is extremely heterogeneous in terms of clinical presentation, pathophysiology, and outcome. Current approaches to the critical care management of TBI are not underpinned by high-quality evidence, and many of the current therapies in use have not shown benefit in randomized control trials...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28167543/carbapenem-minimal-inhibitory-concentrations-in-escherichia-coli-and-klebsiella-species-producing-extended-spectrum-beta-lactamases-esbls-in-critical-care-patients-from-2001-2009
#5
J Kristie Johnson, Gwen L Robinson, Lisa L Pineles, Adebola O Ajao, LiCheng Zhao, Jennifer S Albrecht, Anthony D Harris, Kerri A Thom, Jon P Furuno
Extended spectrum β-lactamase (ESBL) -producing Enterobacteriaceae are increasing in prevalence worldwide. Carbapenem antibiotics are used as a first line of therapy against ESBL-producing Enterobacteriaceae. We examined gastrointestinal colonization of carbapenem-resistant-ESBLs (CR-ESBL) among a cohort of critical care patients. In this cohort of patients, we cultured for ESBL-producing Klebsiella spp. and Escherichia coli and then performed MIC susceptibility testing for imipenem, doripenem, meropenem, and ertapenem on the patient's first isolate...
February 6, 2017: Antimicrobial Agents and Chemotherapy
https://www.readbyqxmd.com/read/28160953/interpreting-laboratory-tests-in-infection-making-sense-of-biomarkers-in-sepsis-and-systemic-inflammatory-response-syndrome-for-intensive-care-unit-patients
#6
REVIEW
Jennifer B Martin, Jennifer E Badeaux
Sepsis and severe sepsis are leading causes of death in the United States and the most common causes of death among critically ill patients in noncoronary intensive care units. Diagnosis of infection and sepsis is a subjective clinical judgment based on the criteria for systemic inflammatory reaction, which is highly sensitive, not specific, and often misleading in intensively treated patients. Biomarkers are emerging as adjuncts to traditional diagnostic measures. No biomarkers have sufficient specificity or sensitivity to be routinely used in clinical practice, but they can aid in the diagnosis and treatment of infection versus inflammation...
March 2017: Critical Care Nursing Clinics of North America
https://www.readbyqxmd.com/read/28160952/antibiotic-trends-amid-multidrug-resistant-gram-negative-infections-in-intensive-care-units
#7
REVIEW
Leanne H Fowler, Susan Lee
Isolates from ICUs most commonly find multidrug-resistant (MDR) gram-negative bacteria. The purpose of this article is to discuss the significant impact MDR gram-negative infections are having on ICUs, the threat on health and mortality, and effective and new approaches aimed to combat MDR gram-negative infections in critically ill populations. Inappropriate antibiotic therapies for suspected or documented infections are the leading cause of the emergence of bacterial resistance. A variety of strategies are aimed at combatting this international burden via antibiotic stewardship programs...
March 2017: Critical Care Nursing Clinics of North America
https://www.readbyqxmd.com/read/28160596/continuous-electroencephalography-ceeg-monitoring-and-outcomes-of-critically-ill-patients
#8
Ayaz M Khawaja, Guoqiao Wang, Gary R Cutter, Jerzy P Szaflarski
BACKGROUND It is not clear whether performing continuous EEG (cEEG) in critically ill patients during intensive care unit (ICU) treatment affects outcomes at discharge. MATERIAL AND METHODS We prospectively matched 234 patients who received cEEG (cases) by admission diagnosis and sex to 234 patients who did not receive cEEG (controls) and followed them until discharge. Patients admitted due to seizures were excluded. The primary measures of outcome were Glasgow Coma Scale at Discharge (GCSD) and disposition at discharge, and the secondary measures of outcome were AED modifications, Glasgow Outcomes Scale, and Modified-Rankin Scale...
February 4, 2017: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
https://www.readbyqxmd.com/read/28152138/effect-of-reverse-triage-on-creation-of-surge-capacity-in-a-pediatric-hospital
#9
Gabor D Kelen, Ruben Troncoso, Joshua Trebach, Scott Levin, Gai Cole, Caitlin M Delaney, J Lee Jenkins, James Fackler, Lauren Sauer
Importance: The capacity of pediatric hospitals to provide treatment to large numbers of patients during a large-scale disaster remains a concern. Hospitals are expected to function independently for as long as 96 hours. Reverse triage (early discharge), a strategy that creates surge bed capacity while conserving resources, has been modeled for adults but not pediatric patients. Objective: To estimate the potential of reverse triage for surge capacity in an academic pediatric hospital...
February 6, 2017: JAMA Pediatrics
https://www.readbyqxmd.com/read/28139519/emergence-of-vancomycin-resistant-enterococci-at-a-teaching-hospital-saudi-arabia
#10
Fawzia E Alotaibi, Elham E Bukhari
BACKGROUND: Vancomycin-resistant enterococci (VRE) are a major and emerging hospital-acquired pathogen associated with high mortality, particularly among the critically ill and Intensive Care Units (ICUs) patients. This study aimed to determine the prevalence and demographic and clinical characteristics of VRE among patients admitted to a university hospital in Riyadh, Saudi Arabia. METHODS: A study was conducted during the period from September 2014 to November 2015 at King Khalid University Hospital, a tertiary care hospital in Riyadh, Saudi Arabia, including in-patients with VRE infection...
2017: Chinese Medical Journal
https://www.readbyqxmd.com/read/28135827/a-conceptual-model-for-the-development-process-of-confirmatory-adaptive-clinical-trials-within-an-emergency-research-network
#11
Samkeliso C Mawocha, Michael D Fetters, Laurie J Legocki, Timothy C Guetterman, Shirley Frederiksen, William G Barsan, Roger J Lewis, Donald A Berry, William J Meurer
BACKGROUND: Adaptive clinical trials use accumulating data from enrolled subjects to alter trial conduct in pre-specified ways based on quantitative decision rules. In this research, we sought to characterize the perspectives of key stakeholders during the development process of confirmatory-phase adaptive clinical trials within an emergency clinical trials network and to build a model to guide future development of adaptive clinical trials. METHODS: We used an ethnographic, qualitative approach to evaluate key stakeholders' views about the adaptive clinical trial development process...
January 1, 2017: Clinical Trials: Journal of the Society for Clinical Trials
https://www.readbyqxmd.com/read/28125855/predictors-and-outcomes-of-acute-pancreatitis-in-critically-ill-patients-presenting-to-the-emergency-department-of-a-tertiary-referral-centre-in-australia
#12
Krishnaswamy Sundararajan, Tom Schoeman, Lara Hughes, Suzanne Edwards, Benjamin Reddi
OBJECTIVE: To provide a current review of the clinical characteristics, predictors and outcomes in critically ill patients presenting to the ED with acute pancreatitis and subsequently admitted to an intensive care unit (ICU) of a tertiary referral centre in Australia. METHODS: A retrospective single-centre study of adult patients admitted with pancreatitis. Severe acute pancreatitis defined by Bedside Index of Severity in Acute Pancreatitis (BISAP) score ≥2. RESULTS: Eighty-seven patients fulfilled criteria for inclusion during the study period, representing 0...
January 26, 2017: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/28124464/patients-experience-of-thirst-while-being-conscious-and-mechanically-ventilated-in-the-intensive-care-unit
#13
Caroline L Kjeldsen, Mette S Hansen, Kamilla Jensen, Anna Holm, Anita Haahr, Pia Dreyer
BACKGROUND: Because of changes in sedation strategies, more patients in the intensive care unit (ICU) are conscious. Therefore, new and challenging tasks in nursing practice have emerged, which require a focus on the problems that patients experience. Thirst is one such major problem, arising because the mechanical ventilator prevents the patients from drinking when they have the urge to do so. To gain a deeper understanding of the patients' experiences and to contribute new knowledge in nursing care, this study focuses on the patients' experiences of thirst during mechanical ventilation (MV) while being conscious...
January 25, 2017: Nursing in Critical Care
https://www.readbyqxmd.com/read/28121217/qsofa-has-poor-sensitivity-for-prehospital-identification-of-severe-sepsis-and-septic-shock
#14
Maia Dorsett, Melissa Kroll, Clark S Smith, Phillip Asaro, Stephen Y Liang, Hawnwan P Moy
OBJECTIVES: Sepsis is a common and deadly disease process for which early recognition and intervention can significantly improve clinical outcomes. Despite this, sepsis remains underrecognized and therefore undertreated in the prehospital setting. Recent recommendations by the Society of Critical Care and European Society of Intensive Care Medicine advocate use of the qSOFA (quick Sequential [Sepsis-related] Organ Failure Assessment) score in non-ICU settings to screen for septic patients at greater risk for poor outcomes...
January 25, 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/28107357/vasopressor-use-for-severe-hypotension-a-multicentre-prospective-observational-study
#15
Francois Lamontagne, Deborah J Cook, Maureen O Meade, Andrew Seely, Andrew G Day, Emmanuel Charbonney, Karim Serri, Yoanna Skrobik, Paul Hebert, Charles St-Arnaud, Hector Quiroz-Martinez, Michaël Mayette, Daren K Heyland
BACKGROUND: The optimal approach to titrate vasopressor therapy is unclear. Recent sepsis guidelines recommend a mean arterial pressure (MAP) target of 65 mmHg and higher for chronic hypertensive patients. As data emerge from clinical trials comparing blood pressure targets for vasopressor therapy, an accurate description of usual care is required to interpret study results. Our aim was to measure MAP values during vasopressor therapy in Canadian intensive care units (ICUs) and to compare these with stated practices and guidelines...
2017: PloS One
https://www.readbyqxmd.com/read/28096296/a-critical-asthma-standardized-clinical-and-management-plan-reduces-duration-of-critical-asthma-therapy
#16
Jackson Wong, Michael S D Agus, Dionne A Graham, Elliot Melendez
BACKGROUND AND OBJECTIVE: Reduction of critical asthma management time can reduce intensive care utilization. The goal of this study was to determine whether a Critical Asthma Standardized Clinical Assessment and Management Plan (SCAMP) can decrease length of critical asthma management time. METHODS: This retrospective study compared critical asthma management times in children managed before and after implementation of a Critical Asthma SCAMP. The SCAMP used an asthma severity score management scheme to guide stepwise escalation and weaning of therapies...
February 2017: Hospital Pediatrics
https://www.readbyqxmd.com/read/28089084/predicting-the-need-for-intra-operative-large-volume-blood-transfusions-during-thoraco-abdominal-aortic-aneurysm-repair
#17
M Pieri, P Nardelli, M De Luca, G Landoni, S Frassoni, G Melissano, A Zangrillo, R Chiesa, F Monaco
OBJECTIVE: Thoraco-abdominal aortic aneurysm (TAAA) repair is a complex procedure performed in patients at high cardiovascular risk. High volume intra-operative bleeding is often recorded, and the amount of intra-operative blood product transfusion is associated with relevant morbidity and mortality. The aim of the study was to identify pre-operative predictors of intra-operative large volume blood transfusions (LVBT) to stratify patients pre-operatively. METHODS: This was a retrospective analysis of prospectively collected data of all patients who underwent open TAAA surgery at San Raffaele Scientific Institute from January 2009 to December 2015...
January 6, 2017: European Journal of Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/28063084/methodological-issues-surrounding-the-use-of-baseline-health-related-quality-of-life-data-to-inform-trial-based-economic-evaluations-of-interventions-within-emergency-and-critical-care-settings-a-systematic-literature-review
#18
REVIEW
Melina Dritsaki, Felix Achana, James Mason, Stavros Petrou
BACKGROUND: Trial-based cost-utility analyses require health-related quality of life data that generate utility values in order to express health outcomes in terms of quality-adjusted life years (QALYs). Assessments of baseline health-related quality of life are problematic where trial participants are incapacitated or critically ill at the time of randomisation. This review aims to identify and critique methods for handling non-availability of baseline health-related quality of life data in trial-based cost-utility analyses within emergency and critical illness settings...
January 6, 2017: PharmacoEconomics
https://www.readbyqxmd.com/read/28045065/high-diversity-of-airborne-fungi-in-the-hospital-environment-as-revealed-by-meta-sequencing-based-microbiome-analysis
#19
Xunliang Tong, Hongtao Xu, Lihui Zou, Meng Cai, Xuefeng Xu, Zuotao Zhao, Fei Xiao, Yanming Li
Invasive fungal infections acquired in the hospital have progressively emerged as an important cause of life-threatening infection. In particular, airborne fungi in hospitals are considered critical pathogens of hospital-associated infections. To identify the causative airborne microorganisms, high-volume air samplers were utilized for collection, and species identification was performed using a culture-based method and DNA sequencing analysis with the Illumina MiSeq and HiSeq 2000 sequencing systems. Few bacteria were grown after cultivation in blood agar...
January 3, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28044337/the-role-and-limitations-of-eeg-based-depth-of-anaesthesia-monitoring-in-theatres-and-intensive-care
#20
REVIEW
Z Hajat, N Ahmad, J Andrzejowski
In this article we will look at some of the principles in processed EEG monitoring as applied to bispectral index (BIS). We outline why BIS should be regarded as a 'memory' monitor which in most circumstances reflects the depth of sedation or anaesthesia in particular patients. Its limitation in paralysed and non-paralysed patients must be understood in order for this monitor to be used safely. Finally, its emerging use in critical care will be explored.
January 2017: Anaesthesia
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