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Intensive care unit;critical care

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https://www.readbyqxmd.com/read/28351063/from-communication-skills-to-skillful-communication-a-longitudinal-integrated-curriculum-for-critical-care-medicine-fellows
#1
Amanda L Roze des Ordons, Christopher J Doig, Philippe Couillard, Jason Lord
PROBLEM: Communication with patients and families in critical care medicine (CCM) can be complex and challenging. A longitudinal curricular model integrating multiple techniques within classroom and clinical milieus may facilitate skillful communication across diverse settings. APPROACH: In 2014-2015, the authors developed and implemented a curriculum for CCM fellows at the Cumming School of Medicine, University of Calgary, to promote the longitudinal development of skillful communication...
April 2017: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/28344751/management-of-critically-ill-patients-with-diabetes
#2
REVIEW
Livier Josefina Silva-Perez, Mario Alberto Benitez-Lopez, Joseph Varon, Salim Surani
Disorders of glucose homeostasis, such as stress-induced hypoglycemia and hyperglycemia, are common complications in patients in the intensive care unit. Patients with preexisting diabetes mellitus (DM) are more susceptible to hyperglycemia, as well as a higher risk from glucose overcorrection, that may results in severe hypoglycemia. In critically ill patients with DM, it is recommended to maintain a blood glucose range between 140-180 mg/dL. In neurological patients and surgical patients, tighter glycemic control (i...
March 15, 2017: World Journal of Diabetes
https://www.readbyqxmd.com/read/28343949/lactate-and-echocardiography-before-veno-venous-extracorporeal-membrane-oxygenation-support
#3
Chiara Lazzeri, Manuela Bonizzoli, Giovanni Cianchi, Stefano Batacchi, Paolo Terenzi, Morena Cozzolino, Pasquale Bernardo, Adriano Peris
BACKGROUND: Lactate has been recognised as a prognostic factor in several critical conditions. Veno-Venous Extracorporeal Membrane Oxygenation (VV-ECMO) is a well-established therapy in patients with Acute Respiratory Disease Syndrome (ARDS) unresponsive to conventional therapy and echocardiography pre ECMO initiation has been recently reported to help in risk stratifying these patients. METHODS: We assessed whether the detection of hyperlactataemia could be associated with the presence of left ventricle (LV) or right ventricle (RV) dysfunction in 121 consecutive patients with refractory ARDS...
March 14, 2017: Heart, Lung & Circulation
https://www.readbyqxmd.com/read/28343416/cuff-leak-test-for-the-diagnosis-of-post-extubation-stridor
#4
David Schnell, Benjamin Planquette, Asaël Berger, Sybille Merceron, Julien Mayaux, Lucas Strasbach, Stéphane Legriel, Sandrine Valade, Michael Darmon, Ferhat Meziani
BACKGROUND: Cuff leak test was developed to predict the occurrence of post-extubation stridor (PES). This study evaluated the diagnostic performance of this test in unselected critically ill patients. METHODS: Multicenter prospective study including unselected ventilated patients at the time of their first planned extubation. The diagnostic performance of 4 different cuff leak tests was assessed. RESULTS: Post-extubation stridor occurred in 34 (9...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/28343092/the-impact-of-cumulative-pain-stress-on-neurobehavioral-development-of-preterm-infants-in-the-nicu
#5
Xiaomei Cong, Jing Wu, Dorothy Vittner, Wanli Xu, Naveed Hussain, Shari Galvin, Megan Fitzsimons, Jacqueline M McGrath, Wendy A Henderson
BACKGROUND: Vulnerable preterm infants experience repeated and prolonged pain/stress stimulation during a critical period in their development while in the neonatal intensive care unit (NICU). The contribution of cumulative pain/stressors to altered neurodevelopment remains unclear. The study purpose was to investigate the impact of early life painful/stressful experiences on neurobehavioral outcomes of preterm infants in the NICU. METHODS: A prospective exploratory study was conducted with fifty preterm infants (28 0/7-32 6/7weeks gestational age) recruited at birth and followed for four weeks...
March 23, 2017: Early Human Development
https://www.readbyqxmd.com/read/28342442/comparison-of-qsofa-and-sirs-for-predicting-adverse-outcomes-of-patients-with-suspicion-of-sepsis-outside-the-intensive-care-unit
#6
Eli J Finkelsztein, Daniel S Jones, Kevin C Ma, Maria A Pabón, Tatiana Delgado, Kiichi Nakahira, John E Arbo, David A Berlin, Edward J Schenck, Augustine M K Choi, Ilias I Siempos
BACKGROUND: The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) Task Force recently introduced a new clinical score termed quick Sequential (Sepsis-related) Organ Failure Assessment (qSOFA) for identification of patients at risk of sepsis outside the intensive care unit (ICU). We attempted to compare the discriminatory capacity of the qSOFA versus the Systemic Inflammatory Response Syndrome (SIRS) score for predicting mortality, ICU-free days, and organ dysfunction-free days in patients with suspicion of infection outside the ICU...
March 26, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28341612/impact-of-%C3%AE-lactam-antibiotic-therapeutic-drug-monitoring-on-dose-adjustments-in-critically-ill-patients-undergoing-continuous-renal-replacement-therapy
#7
Caleb J P Economou, Gloria Wong, Brett McWhinney, Jacobus P J Ungerer, Jeffrey Lipman, Jason A Roberts
The objective of this study was to describe the effect of therapeutic drug monitoring (TDM) and dose adjustments of β-lactam antibiotics administered to critically ill patients undergoing continuous renal replacement therapy (CRRT) in a 30-bed tertiary intensive care unit (ICU). β-Lactam TDM data in our tertiary referral ICU were retrospectively reviewed. Clinical, demographic and dosing data were collected for patients administered β-lactam antibiotics while undergoing CRRT. The target trough concentration range was 1-10× the minimum inhibitory concentration (MIC)...
March 21, 2017: International Journal of Antimicrobial Agents
https://www.readbyqxmd.com/read/28341258/treatment-costs-of-burn-victims-in-a-university-hospital
#8
Elza H T Anami, Elisangela F Zampar, Marcos T Tanita, Lucienne T Q Cardoso, Tiemi Matsuo, Cintia Magalhães C Grion
OBJECTIVES: To analyze the direct costs of treating critically ill patients in the intensive care unit of a center specializing in treating burns. METHODS: This is a prospective cohort study of 180 patients from May 2011 to May 2013. Clinical and demographic data were collected in addition to data for the calculation of severity scores. The costs related to daily clinical and surgical treatment were evaluated until hospital outcome. The costs were grouped into five blocks: Clinical support, Drugs and blood products, Medical procedures, Specific burn procedures and Hospital fees...
March 2017: Burns: Journal of the International Society for Burn Injuries
https://www.readbyqxmd.com/read/28337077/antithrombin-iii-doses-rounded-to-available-vial-sizes-in-critically-ill-pediatric-patients
#9
Winifred M Stockton, Eimeira Padilla-Tolentino, Carolyn E Ragsdale
OBJECTIVES: Children have decreased levels of antithrombin III (AT III) compared to adults. These levels may be further decreased during acute illness. Administration of exogenous AT III can increase anticoagulant efficacy. The objective of this study was to evaluate AT III doses rounded to available vial sizes compared to partial vial doses in critically ill pediatric patients, including patients receiving extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT)...
January 2017: Journal of Pediatric Pharmacology and Therapeutics: JPPT: the Official Journal of PPAG
https://www.readbyqxmd.com/read/28335673/modifiable-risk-factors-for-delirium-in-critically-ill-trauma-patients
#10
Marc-Alexandre Duceppe, David R Williamson, Audrée Elliott, Mélissa Para, Marie-Christine Poirier, Marie-Soleil Delisle, Dan Deckelbaum, Tarek Razek, Monique Desjardins, Jean-Claude Bertrand, Francis Bernard, Philippe Rico, Lisa Burry, Anne Julie Frenette, Marc Perreault
OBJECTIVE: Intensive care unit (ICU)-acquired delirium has been associated with increased morbidity and mortality. Prevention strategies including modification of delirium risk factors are emphasized by practice guidelines. No study has specifically evaluated modifiable delirium risk factors in trauma ICU patients. Our goal was to evaluate modifiable risk factors for delirium among trauma patients admitted to the ICU. DESIGN: Prospective observational study. SETTING: Two level 1 trauma ICU centers...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/28332367/value-of-serum-cystatin-c-measurement-in-the-diagnosis-of-sepsis-induced-kidney-injury-and-prediction-of-renal-function-recovery
#11
Ah Young Leem, Moo Suk Park, Byung Hoon Park, Won Jai Jung, Kyung Soo Chung, Song Yee Kim, Eun Young Kim, Ji Ye Jung, Young Ae Kang, Young Sam Kim, Se Kyu Kim, Joon Chang, Joo Han Song
PURPOSE: Acute kidney injury (AKI) is common in critically ill patients. Serum cystatin C has emerged as a reliable marker of AKI. We sought to assess the value of serum cystatin C for early detection and prediction of renal function recovery in patients with sepsis. MATERIALS AND METHODS: Sepsis patients (113 AKI patients and 49 non-AKI patients) admitted to the intensive care unit (ICU) were included. Serum creatinine and cystatin C levels and glomerular filtration rate were measured on days 0, 1, 3, and 7...
May 2017: Yonsei Medical Journal
https://www.readbyqxmd.com/read/28331867/the-content-of-plasma-selenium-in-early-admitted-septic-patients
#12
Omid Moradi Moghaddam, Mohammad Niakan Lahiji, Azadeh Moghaddas, Maryam Farasatinasab, Somayyeh Nasiripour
OBJECTIVE: Selenium depletion has been reported in critical illness correlates with an increase in mortality and morbidity. In this study, we aimed to access the selenium plasma levels of septic patients early at the Intensive Care Unit (ICU) admission in order to compare with reference range. METHODS: We conducted a cross-sectional study in a university affiliated hospital aiming to assess the early plasma level of selenium in ICU admitted patients. eighty patients diagnoses with sepsis were included and considered for characteristic evaluation, monitoring criteria assessment and also blood sampling...
January 2017: Journal of Research in Pharmacy Practice
https://www.readbyqxmd.com/read/28331622/c-terminal-proendothelin-1-ct-proet-1-is-associated-with-organ-failure-and-predicts-mortality-in-critically-ill-patients
#13
Lukas Buendgens, Eray Yagmur, Jan Bruensing, Ulf Herbers, Christer Baeck, Christian Trautwein, Alexander Koch, Frank Tacke
BACKGROUND: Endothelin 1 (ET-1) is a strong vasoconstrictor, which is involved in inflammation and reduced tissue perfusion. C-terminal proendothelin-1 (CT-proET-1) is the stable circulating precursor protein of ET-1. We hypothesized that CT-proET-1, reflecting ET-1 activation, is involved in the pathogenesis of critical illness and associated with its prognosis. METHODS: Two hundred seventeen critically ill patients (144 with sepsis, 73 without sepsis) were included prospectively upon admission to the medical intensive care unit (ICU), in comparison to 65 healthy controls...
2017: Journal of Intensive Care
https://www.readbyqxmd.com/read/28329734/elevated-mif-2-levels-predict-mortality-in-critically-ill-patients
#14
Julia Pohl, Ulrike B Hendgen-Cotta, Pia Stock, Peter Luedike, Tienush Rassaf
PURPOSE: D-dopachrome tautomerase (MIF-2 or DDT) is a member of the macrophage migration inhibitory factor (MIF) superfamily and a close structural homolog to MIF. Circulating MIF-2 has been described to be elevated in patients suffering from sepsis, severe burn injury and after surgery. We sought to evaluate the prognostic value of MIF-2 in critically ill patients. METHODS: A total of 72 patients were studied upon admission to the medical intensive care unit (ICU)...
March 16, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28329238/practice-patterns-and-outcomes-associated-with-procalcitonin-use-in-critically-ill-patients-with-sepsis
#15
David C Chu, Anuj B Mehta, Allan J Walkey
Background: Randomized trials support use of procalcitonin-based algorithms to decrease duration of antibiotics for critically ill patients with sepsis. However, current utilization of procalcitonin and associated outcomes in "real world" clinical settings is unclear. We sought to determine procalcitonin utilization in critically ill patients with sepsis in the United States and to examine associations between procalcitonin use and clinical outcomes. Methods: Retrospective cohort study of approximately 20% of patients hospitalized in US Intensive Care Units with sepsis...
February 24, 2017: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/28328824/early-use-of-noninvasive-techniques-for-clearing-respiratory-secretions-during-noninvasive-positive-pressure-ventilation-in-patients-with-acute-exacerbation-of-chronic-obstructive-pulmonary-disease-and-hypercapnic-encephalopathy-a-prospective-cohort-study
#16
Jinrong Wang, Zhaobo Cui, Shuhong Liu, Xiuling Gao, Pan Gao, Yi Shi, Shufen Guo, Peipei Li
Noninvasive positive-pressure ventilation (NPPV) might be superior to conventional mechanical ventilation (CMV) in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPDs). Inefficient clearance of respiratory secretions provokes NPPV failure in patients with hypercapnic encephalopathy (HE). This study compared CMV and NPPV combined with a noninvasive strategy for clearing secretions in HE and AECOPD patients.The present study is a prospective cohort study of AECOPD and HE patients enrolled between October 2013 and August 2015 in a critical care unit of a major university teaching hospital in China...
March 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28328711/management-of-atrial-fibrillation-with-rapid-ventricular-response-in-the-intensive-care-unit-a-secondary-analysis-of-electronic-health-record-data
#17
Ari Moskowitz, Kenneth P Chen, Avraham Z Cooper, Abdullah Chahin, Mohammad M Ghassemi, Leo Anthony Celi
PURPOSE: Atrial fibrillation with rapid ventricular response (RVR) is common during critical illness. In this study, we explore the comparative effectiveness of three commonly used drugs (metoprolol, diltiazem, and amiodarone) in the management of atrial fibrillation with RVR in the intensive care unit (ICU). METHODS: Data pertaining to the first ICU admission were extracted from the Medical Information Mart for Intensive Care (MIMIC) III database. Patients who received one of the above pharmacologic agents while their heart rate was > 110bpm and had atrial fibrillation documented in the clinical chart were included...
March 21, 2017: Shock
https://www.readbyqxmd.com/read/28328654/outcomes-for-children-receiving-noninvasive-ventilation-as-the-first-line-mode-of-mechanical-ventilation-at-intensive-care-admission-a-propensity-score-matched-cohort-study
#18
Jenny V Morris, Padmanabhan Ramnarayan, Roger C Parslow, Sarah J Fleming
OBJECTIVES: To compare outcomes of children receiving noninvasive ventilation with those receiving invasive ventilation as first-line mode of mechanical ventilation following unplanned intensive care admission. DESIGN: Propensity score-matched cohort study analyzing data prospectively collected by the Pediatric Intensive Care Audit Network over 8 years (2007-2014). SETTING: Thirty-one PICUs in the United Kingdom and Ireland; twenty-one of whom submitted Pediatric Critical Care Minimum Dataset data for the entire study period...
March 21, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28328388/bedside-critical-care-staff-use-of-intensive-care-unit-telemedicine-comparisons-by-intensive-care-unit-complexity
#19
Jonathan T Thomas, Jane Moeckli, Michelle A Mengeling, Cassie Cunningham Goedken, Jacinda Bunch, Peter Cram, Heather Schacht Reisinger
BACKGROUND: Effects of Intensive Care Unit (ICU) telemedicine on patient and staff outcomes are mixed. Variation in utilization is potentially driving these differences. INTRODUCTION: ICU telemedicine utilization is understudied, with existing research focusing on telemedicine staff. We assess ICU telemedicine utilization from the perspective of the end user-ICU staff-to better understand how telemedicine use is conceptualized and practiced at the bedside. MATERIALS AND METHODS: We conducted a thematic content analysis of semistructured interviews with bedside ICU staff...
February 16, 2017: Telemedicine Journal and E-health: the Official Journal of the American Telemedicine Association
https://www.readbyqxmd.com/read/28328262/haemodialysis-nutritional-disorders-and-hypoglycaemia-in-critical-care
#20
Jeiel Carlos Lamonica Crespo, Vanessa Rossato Gomes, Ricardo Luís Barbosa, Katia Grillo Padilha, Silvia Regina Secoli
This study aimed to determine hypoglycemia incidence and associated factors in critically ill patients. It looked at a retrospective cohort with 106 critically ill adult patients with 48 hours of glycaemic control and 72 hours of follow up. The dependent variable, hypoglycaemia (≤70 mg/dl), was assessed with respect to independent variables: age, diet, insulin, catecholamines, haemodialysis, nursing workload and the Simplified Acute Physiology Score. Statistical analysis was performed using Student's t-test, Fisher's exact test and logistic regression at 5% significance level...
March 9, 2017: British Journal of Nursing: BJN
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