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Critical ill

Amanda C Capino, Jamie L Miller, Peter N Johnson
The need for sedation and analgesia and treatment of iatrogenic drug withdrawal is common in critically ill children. First-line therapy typically includes opioid agonists. However, clonidine, a central alpha2 agonist, has been suggested as a treatment option for sedation and analgesia and iatrogenic drug withdrawal. Therefore, we conducted a literature search to identify articles evaluating the use of enteral and transdermal clonidine in critically ill infants and children for sedation and analgesia and treatment of iatrogenic drug withdrawal...
October 25, 2016: Pharmacotherapy
Ryan M J Ivie, Emily A Vail, Hannah Wunsch, Monica P Goldklang, Robert Fowler, Vivek K Moitra
OBJECTIVE: We conducted this study to determine the generalizability of information gained from randomized controlled trials in critically ill patients by assessing the incidence of eligibility for each trial. DESIGN: Prospective, observational cohort study. We identified the 15 most highly cited randomized controlled trials in critical care medicine published between 1998 and 2008. We examined the inclusion and exclusion criteria for each randomized controlled trial and then assessed the eligibility of each patient admitted to a study ICU for each randomized controlled trial and calculated rates of potential trial eligibility in the cohort...
October 24, 2016: Critical Care Medicine
Emily E Whitgob, Rebecca L Blankenburg, Alyssa L Bogetz
PURPOSE: Trainee mistreatment remains an important and serious medical education issue. Mistreatment toward trainees by the medical team has been described; mistreatment by patients and families has not. Motivated by discrimination towards a resident by a family in their emergency department, the authors sought to identify strategies for trainees and physicians to respond effectively to mistreatment by patients and families. METHOD: A purposeful sample of pediatric faculty educational leaders was recruited from April-June 2014 at Stanford University...
November 2016: Academic Medicine: Journal of the Association of American Medical Colleges
Fang Hua, Huixu Xie, Helen V Worthington, Susan Furness, Qi Zhang, Chunjie Li
BACKGROUND: Ventilator-associated pneumonia (VAP) is defined as pneumonia developing in people who have received mechanical ventilation for at least 48 hours. VAP is a potentially serious complication in these patients who are already critically ill. Oral hygiene care (OHC), using either a mouthrinse, gel, toothbrush, or combination, together with aspiration of secretions, may reduce the risk of VAP in these patients. OBJECTIVES: To assess the effects of oral hygiene care on incidence of ventilator-associated pneumonia in critically ill patients receiving mechanical ventilation in hospital intensive care units (ICUs)...
October 25, 2016: Cochrane Database of Systematic Reviews
Katerina Vaporidi, Dimitris Babalis, Achilleas Chytas, Emmanuel Lilitsis, Eumorfia Kondili, Vasilis Amargianitakis, Ioanna Chouvarda, Nicos Maglaveras, Dimitris Georgopoulos
PURPOSE: The aim of this study was to investigate the role of ineffective efforts (IEs), specifically clusters of IEs, during mechanical ventilation on the outcome of critically ill patients. METHODS: In a prospective observational study, 24-h recordings were obtained in 110 patients on the 1st day of assisted ventilation (pressure support or proportional assist), using a prototype monitor validated to identify IEs. Patients remaining on assisted ventilation were studied again on the 3rd day (n = 37) and on the 6th day (n = 13)...
October 24, 2016: Intensive Care Medicine
Matthaios Papadimitriou-Olivgeris, Diamanto Aretha, Anastasia Zotou, Kyriaki Koutsileou, Aikaterini Zbouki, Aikaterini Lefkaditi, Christina Sklavou, Markos Marangos, Fotini Fligou
Background. The objective of this study was to assess the correlation between sepsis, obesity, and mortality of patients admitted to an Intensive Care Unit (ICU). Subjects and Methods. Data of all patients admitted to the ICU of a tertiary hospital during a 28-month period were retrospectively analyzed and included in the study. Results. Of 834 patients included, 163 (19.5%) were obese, while 25 (3.0%) were morbidly obese. Number of comorbidities (P < 0.001), bloodstream infection (P  0.033), and carbapenemase-producing Klebsiella pneumoniae colonization during ICU stay (P  0...
2016: BioMed Research International
Hedwig Schroeck, Angela K Lyden, Wendy L Benedict, Satya Krishna Ramachandran
Background. Despite increasing adoption of active warming methods over the recent years, little is known about the effectiveness of these interventions on the occurrence of abnormal postoperative temperatures in sick infants. Methods. Preoperative and postoperative temperature readings, patient characteristics, and procedural factors of critically ill infants at a single institution were retrieved retrospectively from June 2006 until May 2014. The primary endpoints were the incidence and trend of postoperative hypothermia and hyperthermia on arrival at the intensive care units...
2016: Anesthesiology Research and Practice
Eric Ehieli, Suraj Yalamuri, Charles S Brudney, Srinivas Pyati
Critically ill patients are a heterogeneous group with diverse comorbidities and physiological derangements. The management of pain in the critically ill population is emerging as a standard of care in the intensive care unit (ICU). Pain control of critically ill patients in the ICU presents numerous challenges to intensivists. Inconsistencies in pain assessment, analgesic prescription and variation in monitoring sedation and analgesia result in suboptimal pain management. Inadequate pain control can have deleterious effects on several organ systems in critically ill patients...
October 24, 2016: Postgraduate Medical Journal
M Bodí, I Oliva, M C Martín, G Sirgo
Real-time random safety audits constitute a tool designed to transfer knowledge from the sources of scientific evidence to the patient bedside. It has proven useful in critically ill patients, improving safety in the process of critical patient care, turning unsafe situations into safe ones in daily practice, and ensuring adherence to scientific evidence. In parallel, the design and methodology involved affords process indicators that will make it possible to know how we provide care for our patients, evolution over time (with regular feedback for professionals), the impact of our interventions, and benchmarking...
October 21, 2016: Medicina Intensiva
Rocío Rodríguez-Rey, Jesús Alonso-Tapia, Nancy Kassam-Adams, Helena Garrido-Hernansaiz
BACKGROUND: Posttraumatic growth (PTG) was conceptualized as consisting of changes in three broad dimensions; Self, interpersonal relationships, and philosophy of life. The aim of this study is to analyze the factor structure of the Posttraumatic Growth Inventory (PTGI) in a sample of parents whose children had survived a critical hospitalization in order to consider the structural validity of the PTGI scores for this population and to report our understanding of PTG as a construct. METHODS: 143 parents completed the PTGI 6 months after their child’s discharge from pediatric intensive care...
November 2016: Psicothema
Victoria L Ewing, Rachel Tolhurst, Andrew Kapinda, Esther Richards, Dianne J Terlouw, David G Lalloo
BACKGROUND: This study used qualitative methods to investigate the relationship between geographic access and gendered intra-household hierarchies and how these influence treatment-seeking decision-making for childhood fever within the Chikwawa district of Malawi. Previous cross-sectional survey findings in the district indicated that distance from facility and associated costs are important determinants of health facility attendance in the district. This paper uses qualitative data to add depth of understanding to these findings by exploring the relationship between distance from services, anticipated costs and cultural norms of intra-household decision-making, and to identify potential intervention opportunities to reduce challenges experienced by those in remote locations...
October 24, 2016: Malaria Journal
Nawal Salahuddin, Alaa Mohamed, Nadia Alharbi, Hamad Ansari, Khaled J Zaza, Qussay Marashly, Iqbal Hussain, Othman Solaiman, Torbjorn V Wetterberg, Khalid Maghrabi
BACKGROUND: Unexplained coma after critical illness can be multifactorial. We evaluated the diagnostic ability of bedside Optic Nerve Sheath Diameter [ONSD] as a screening test for non-traumatic radiographic cerebral edema. METHODS: In a prospective study, mixed medical-surgical intensive care units [ICU] patients with non-traumatic coma [GCS < 9] underwent bedside ultrasonographic ONSD measurements. Non-traumatic radiographic cerebral edema [NTRCE] was defined as > 5 mm midline shift, cisternal, sulcal effacement, or hydrocephalus on CT...
October 25, 2016: BMC Anesthesiology
Saraschandra Vallabhajosyula, Arun Kanmanthareddy, Patricia J Erwin, Dennis J Esterbrooks, Lee E Morrow
BACKGROUND: The data evaluating the role of statins in delirium prevention in the intensive care unit are conflicting and limited. METHODS: We performed a systematic review and meta-analysis of literature from 1975 to 2015. All English-language adult studies evaluating delirium incidence in statin and statin nonusers were included and studies without a control group were excluded. Mantel-Haenszel model was used to calculate pooled risk ratios (RRs) and 95% confidence intervals (CIs)...
October 8, 2016: Journal of Critical Care
Bin Wang, Suijun Liu, Ling Li, Qiuming Yao, Ronghua Song, Xiaoqing Shao, Qian Li, Xiaohong Shi, Jin-An Zhang
BACKGROUND: Non-thyroidal illness syndrome (NTIS) is characterized by decreased serum triiodothyronine level without increased thyroid-stimulating hormone level during critical illness. The summary data on the prevalence of NTIS in cardiovascular patients are lacking, and its prognostic role in cardiovascular patients is also unclear. METHODS: We performed a systematic review and meta-analysis to comprehensively determine the prevalence and the prognostic role of NTIS in cardiovascular patients...
October 18, 2016: International Journal of Cardiology
Anthony A Iwuafor, Folasade T Ogunsola, Rita O Oladele, Oyin O Oduyebo, Ibironke Desalu, Chukwudi C Egwuatu, Agwu U Nnachi, Comfort N Akujobi, Ita O Ita, Godwin I Ogban
BACKGROUND: Infections are common complications in critically ill patients with associated significant morbidity and mortality. AIM: This study determined the prevalence, risk factors, clinical outcome and microbiological profile of hospital-acquired infections in the intensive care unit of a Nigerian tertiary hospital. MATERIALS AND METHODS: This was a prospective cohort study, patients were recruited and followed up between September 2011 and July 2012 until they were either discharged from the ICU or died...
2016: PloS One
Melanie Meersch, Christoph Schmidt, Joachim Schmidt, Alexander Zarbock
No abstract text is available yet for this article.
September 2016: Annals of Translational Medicine
Ashley M Smith, Amanda Jensen-Doss
Improving mental health services for youth in usual care (UC) is one of the most critical issues in mental health services research. Identification of change groups in UC (e.g., recovery, improvement, no response, deterioration) can help researchers gain a richer understanding of UC and facilitate efforts to tailor UC to individuals who may not be responding well to treatment. This study used the reliable change index (RCI; Jacobson & Truax, 1991) to examine change groups within youth UC on two parent report outcome measures-symptom severity and functioning-using a large, naturalistic sample of youth (N = 672) treated in UC served at four clinics operating under a large county-wide public mental health authority...
October 24, 2016: Psychological Services
Matteo Di Nardo, Graeme MacLaren, Marco Marano, Corrado Cecchetti, Paola Bernaschi, Antonio Amodeo
Extracorporeal life support (ECLS) is an important device in the management of children with severe refractory cardiac and or pulmonary failure. Actually, two forms of ECLS are available for neonates and children: extracorporeal membrane oxygenation (ECMO) and use of a ventricular assist device (VAD). Both these techniques have their own advantages and disadvantages. The intra-aortic balloon pump is another ECLS device that has been successfully used in larger children, adolescents, and adults, but has found limited applicability in smaller children...
2016: Frontiers in Pediatrics
Joerg C Schefold, Mitja Lainscak, Lea Majc Hodoscek, Stefan Blöchlinger, Wolfram Doehner, Stephan von Haehling
BACKGROUND: Acute heart failure (AHF) is a leading cause of death in critically ill patients and is often accompanied by significant renal dysfunction. Few data exist on the predictive value of measures of renal dysfunction in large cohorts of patients hospitalized for AHF. METHODS: Six hundred and eighteen patients hospitalized for AHF (300 male, aged 73.3 ± 10.3 years, 73% New York Heart Association Class 4, mean hospital length of stay 12.9 ± 7.7 days, 97% non-ischaemic AHF) were included in a retrospective single-centre data analysis...
December 2015: ESC Heart Failure
Ankana Daga, Fredrick Dapaah-Siakwan, Sharina Rajbhandari, Cassandra Arevalo, Agnes Salvador
BACKGROUND: Acute kidney injury (AKI) is common in critically ill premature infants. There is a lack of consensus on the diagnostic definition of AKI in very low birth weight (VLBW) infants. The primary aim of this study was to determine the incidence and risk factors for AKI in VLBW infants using the AKI network (AKIN) and pRIFLE (pediatric Risk, Injury, Failure, Loss, End-Stage) criteria and to evaluate whether Clinical Risk Index for Babies (CRIB II) score is a predictor of AKI. The secondary objective was to determine the extent of agreement between the AKIN and pRIFLE criteria in the diagnosis of AKI in VLBW infants...
September 28, 2016: Pediatrics and Neonatology
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