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Interactions intensive care unit

Fawaz Al-Mufti, Kalina Anna Misiolek, David Roh, Aws Alawi, Andrew Bauerschmidt, Soojin Park, Sachin Agarwal, Philip M Meyers, E Sander Connolly, Jan Claassen, J Michael Schmidt
BACKGROUND: Immune dysregulation has long been implicated in the development of delayed cerebral ischemia (DCI) following aneurysmal subarachnoid hemorrhage (aSAH). OBJECTIVE: To determine the relationship of inflammatory cell biomarkers with DCI. METHODS: We evaluated 849 aSAH patients who were enrolled into a prospective observational cohort study and had a white blood cell (WBC) differential obtained within 72 h of bleed onset. RESULTS: WBC count > 12...
March 8, 2018: Neurosurgery
S Hoang, A Georget, J Asselineau, A-G Venier, C Leroyer, A M Rogues, R Thiébaut
OBJECTIVE: To assess the role of environment, medical care and individual risks factors for P. aeruginosa colonization and infection. STUDY DESIGN AND SETTING: A French multicentric prospective study involved ten ICUs for a five months period. Every adult patient newly hospitalized in ICUs with no P. aeruginosa carriage up to 48 hours after admission was included and weekly screened before discharge or death. Screening swabs were either rectal, sputum or oropharyngeal samples...
2018: PloS One
Mona Pauline Voie, Jorunn Tunby, Nina Strømsvik
AIM: To explore the collaboration challenges faced by neonatal intensive care unit (NICU) nurses and public health nurses when preparing premature infants for transition home and to explore the culture of cooperation between the two professional groups. METHOD: Qualitative individual interviews were undertaken with two NICU nurses and two public health nurses. A qualitative content analysis was used to analyse the data. FINDINGS: Three main themes were identified: different expectations and lack of communication between NICU nurses and public health nurses; responsibilities and interactions between the two professional groups were not clearly defined; and the public health nurses' competence was not recognised by the NICU nurses and parents...
March 7, 2018: Nursing Children and Young People
Takeshi Yamamoto
High-risk pulmonary embolism (PE) is a life-threatening disorder associated with high mortality and morbidity. Most deaths in patients with shock occur within the first few hours after presentation, and rapid diagnosis and treatment is therefore essential to save patients' lives. The main manifestations of major PE are acute right ventricular (RV) failure and hypoxia. RV pressure overload is predominantly related to the interaction between the mechanical pulmonary vascular obstruction and the underlying cardiopulmonary status...
2018: Journal of Intensive Care
D Dante Yeh, Eva Fuentes, Sadeq A Quraishi, Jarone Lee, Haytham M A Kaafarani, Peter Fagenholz, Kathryn Butler, Marc DeMoya, Yuchiao Chang, George Velmahos
BACKGROUND: Failure to provide adequate nutrition in the intensive care unit (ICU) may be particularly harmful for patients with prolonged critical illness. We hypothesized that early nutrition inadequacy is more influential for those requiring a longer ICU stay versus those requiring a shorter stay. METHODS: We enrolled 280 adult patients with prolonged surgical ICU stay who were receiving enteral nutrition for >72 hours. Subjects were divided into 2 groups: shortICU (<14 days) and longICU (≥14 days)...
January 2018: JPEN. Journal of Parenteral and Enteral Nutrition
Weisheng Chen, Cheng Sun, Ru Wei, Yanlin Zhang, Heng Ye, Ruibin Chi, Yichen Zhang, Bei Hu, Bo Lv, Lifang Chen, Xiunong Zhang, Huilan Lan, Chunbo Chen
BACKGROUND: Despite the use of prokinetic agents, the overall success rate for postpyloric placement via a self-propelled spiral nasoenteric tube is quite low. METHODS: This retrospective study was conducted in the intensive care units of 11 university hospitals from 2006 to 2016 among adult patients who underwent self-propelled spiral nasoenteric tube insertion. Success was defined as postpyloric nasoenteric tube placement confirmed by abdominal x-ray scan 24 hours after tube insertion...
January 2018: JPEN. Journal of Parenteral and Enteral Nutrition
Lise Bernard, Teuta Eljezi, Hélène Clauson, Céline Lambert, Yassine Bouattour, Philip Chennell, Bruno Pereira, Valérie Sautou
Infusion medical devices (MDs) used in hospitals are often made of plasticized polyvinylchloride (PVC). These plasticizers may leach out into infused solutions during clinical practice, especially during risk-situations, e.g multiple infusions in Intensive Care Units and thus may enter into contact with the patients. The migrability of the plasticizers is dependent of several clinical parameters such as temperature, contact time, nature of the simulant, etc… However, no data is available about the influence of the flow rate at which drug solutions are administrated...
2018: PloS One
Cecilia Villa Etchegoyen, Guillermo Alberto Keller, Sebastian Mrad, Sixuan Cheng, Guillermo DiGirolamo
Drug-induced QT interval prolongation is the most frequent cause of Long QT syndrome (LQTS) in the clinical practice. This electrophysiological entity, produced by an extended duration of the myocardial repolarization and reflected as a prolonged QT interval in the superficial electrocardiogram (EKG), increases the risk of polymorphic ventricular tachycardia (Torsades de Pointes) appearance and sudden death. Certain antiarrhythmic drugs such as amiodarone, sotalol, quinidine, procainamide, verapamil and diltiazem are known as drugs that, due to their mechanism of action, prolong the QT interval, demanding constant monitorization...
February 23, 2018: Current Clinical Pharmacology
Alberto Porta, Riccardo Colombo, Andrea Marchi, Vlasta Bari, Beatrice De Maria, Giovanni Ranuzzi, Stefano Guzzetti, Tommaso Fossali, Ferdinando Raimondi
This study checks whether autonomic markers derived from spontaneous fluctuations of heart period (HP) and systolic arterial pressure (SAP) and from their interactions with spontaneous or mechanical respiration (R) are associated with mortality in patients admitted to intensive care unit (ICU). Three-hundred consecutive HP, SAP and R values were recorded during the first day in ICU in 123 patients. Population was divided into survivors (SURVs, n = 83) and non-survivors (NonSURVs, n = 40) according to the outcome...
February 22, 2018: Scientific Reports
Heitor Pons Leite, Lúcio Flávio Peixoto de Lima, José Augusto de A C Taddei, Ângela Tavares Paes
OBJECTIVE: To test the hypothesis that low blood thiamine concentrations in malnourished critically ill children are associated with higher risk of 30-d mortality. METHODS: Prospective cohort study in 202 consecutively admitted children who had whole blood thiamine concentrations assessed on admission and on days 5 and 10 of intensive care unit (ICU) stay. The primary outcome variable was 30-d mortality. Mean blood thiamine concentrations within the first 10 d of ICU stay, age, sex, malnutrition, C-reactive protein concentration, Pediatric Index of Mortality 2 score, and severe sepsis/septic shock were the main potential exposure variables for outcome...
December 7, 2017: Nutrition
Dora Wood, Sophie Geoghegan, Padmanabhan Ramnarayan, Peter J Davis, John V Pappachan, Sarah Goodwin, Jo Wray
Critically ill adolescents are usually treated on intensive care units optimised for much older adults or younger children. The way they access and experience health services may be very different to most adolescent service users, and existing quality criteria may not apply to them. The objectives of this pilot study were, firstly, to determine whether adolescents and their families were able to articulate their experiences of their critical care admission and secondly, to identify the factors that are important to them during their intensive care unit (ICU) or high dependency unit (HDU) stay...
February 21, 2018: European Journal of Pediatrics
Grazielle Viana Ramos, André Miguel Japiassú, Fernando Augusto Bozza, Lusiele Guaraldo
OBJECTIVES: The aim of this study was to develop a strategy to identify adverse drug events associated with drug-drug interactions by analyzing the prescriptions of critically ill patients. METHODS: This retrospective study included HIV/AIDS patients who were admitted to an intensive care unit between November 2006 and September 2008. Data were collected in two stages. In the first stage, three prescriptions administered throughout the entire duration of these patients' hospitalization were reviewed, with the Micromedex database used to search for potential drug-drug interactions...
February 19, 2018: Clinics
Rajesh M Shetty, Antonio Bellini, Dhuleep S Wijayatilake, Mark A Hamilton, Rajesh Jain, Sunil Karanth, ArunKumar Namachivayam
BACKGROUND: Patients admitted to intensive care and on mechanical ventilation, are administered sedative and analgesic drugs to improve both their comfort and interaction with the ventilator. Optimizing sedation practice may reduce mortality, improve patient comfort and reduce cost. Current practice is to use scales or scores to assess depth of sedation based on clinical criteria such as consciousness, understanding and response to commands. However these are perceived as subjective assessment tools...
February 21, 2018: Cochrane Database of Systematic Reviews
Marina Florés, Montserrat Martinez-Alonso, Alicia Sánchezde-la-Torre, Albina Aldomà, Estefania Galera, Ferran Barbé, Manuel Sánchezde-la-Torre, Mireia Dalmases
Background: Continuous positive airway pressure (CPAP) is an effective treatment for obstructive sleep apnoea (OSA), but an evaluation of CPAP adherence is rarely carried out among patients with acute coronary syndrome (ACS). The goals of the study are to analyse long-term adherence and identify the predictors of non-compliance with CPAP treatment for patients with non-sleepy OSA and ACS. Methods: This is an ancillary study of the ISAACC study, which is a multicentre, prospective, open-label, parallel, randomized, and controlled trial (NCT01335087) in patients with hospital admission for ACS...
January 2018: Journal of Thoracic Disease
Peter Barr
AIMS: The study aim was to determine the direct and indirect relations of the five-factor model of personality traits and work stress with professional quality of life in neonatal nurses. BACKGROUND: Neonatal intensive care nursing has positive and negative effects on neonatal nurses' psychological well-being. Although individual and situational factors interact to influence professional quality of life, there have been few studies of these relationships in neonatal nurses...
February 14, 2018: Journal of Advanced Nursing
Adrian Wong, Mary G Amato, Diane L Seger, Christine Rehr, Adam Wright, Sarah P Slight, Patrick E Beeler, E John Orav, David W Bates
BACKGROUND: Clinical decision support (CDS) displayed in electronic health records has been found to reduce the incidence of medication errors and adverse drug events (ADE). Recent data suggested that medication-related CDS alerts were frequently over-ridden, often inappropriately. Patients in the intensive care unit (ICU) are at an increased risk of ADEs; however, limited data exist on the benefits of CDS in the ICU. This study aims to evaluate potential harm associated with medication-related CDS over-rides in the ICU...
February 9, 2018: BMJ Quality & Safety
Xiao Yu, Nicholas P Franks, William Wisden
Sedatives target just a handful of receptors and ion channels. But we have no satisfying explanation for how activating these receptors produces sedation. In particular, do sedatives act at restricted brain locations and circuitries or more widely? Two prominent sedative drugs in clinical use are zolpidem, a GABAA receptor positive allosteric modulator, and dexmedetomidine (DEX), a selective α2 adrenergic receptor agonist. By targeting hypothalamic neuromodulatory systems both drugs induce a sleep-like state, but in different ways: zolpidem primarily reduces the latency to NREM sleep, and is a controlled substance taken by many people to help them sleep; DEX produces prominent slow wave activity in the electroencephalogram (EEG) resembling stage 2 NREM sleep, but with complications of hypothermia and lowered blood pressure-it is used for long term sedation in hospital intensive care units-under DEX-induced sedation patients are arousable and responsive, and this drug reduces the risk of delirium...
2018: Frontiers in Neural Circuits
A Rodríguez, L F Reyes, J Monclou, B Suberviola, M Bodí, G Sirgo, J Solé-Violán, J Guardiola, D Barahona, E Díaz, I Martín-Loeches, M I Restrepo
INTRODUCTION: Serum procalcitonin (PCT) concentration could be increased in patients with renal dysfunction in the absence of bacterial infection. OBJECTIVE: To determine the interactions among serum renal biomarkers of acute kidney injury (AKI) and serum PCT concentration, in patients admitted to the intensive care unit (ICU) due to lung influenza infection. DESIGN: Secondary analysis of a prospective multicentre observational study. SETTING: 148 Spanish ICUs...
February 9, 2018: Medicina Intensiva
Marc Turon, Sol Fernández-Gonzalo, Candelaria de Haro, Rudys Magrans, Josefina López-Aguilar, Lluís Blanch
Critical illness may lead to significant long-term neurological morbidity and patients frequently develop neuropsychological disturbances including acute delirium or memory impairment after intensive care unit (ICU) discharge. Mechanical ventilation (MV) is a risk factor to the development of adverse neurocognitive outcomes. Patients undergoing MV for long periods present neurologic impairment with memory and cognitive alteration. Delirium is considered an acute form of brain dysfunction and its prevalence rises in mechanically ventilated patients...
January 2018: Annals of Translational Medicine
Antonio Mauricio Dos Santos Cerqueira Junior, Luisa Gondim Dos Santos Pereira, Thiago Menezes Barbosa de Souza, Vitor Calixto de Almeida Correia, Felipe Kalil Beirão Alexandre, Gabriella Sant'Ana Sodré, Jessica Gonzalez Suerdieck, Felipe Ferreira, Marcia Maria Noya Rabelo, Luis Cláudio Lemos Correia
BACKGROUND: The GRACE Score was derived and validated from a cohort in which octogenarians and nonagenarians were poorly represented. OBJECTIVE: To test the accuracy of the GRACE score in predicting in-hospital mortality of very elderly individuals with acute coronary syndromes (ACS). METHODS: Prospective observational study conducted in the intensive coronary care unit of a tertiary center from September 2011 to August 2016. Patients consecutively admitted due to ACS were selected, and the very elderly group was defined by age ≥ 80 years...
February 1, 2018: Arquivos Brasileiros de Cardiologia
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