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Critical care patient

Adrien Koeltz, Stephane Lastere, Sylvain Jean-Baptiste
During the 2014-2015 chikungunya outbreak in French Polynesia, 64 patients with confirmed chikungunya virus infection were admitted into intensive care. Sixty-three were nonpregnant adults; 11 had an atypical form, 21 had severe sepsis or septic shock, and 18 died. These findings indicate that critical illness frequently complicates the course of chikungunya virus infection.
April 2018: Emerging Infectious Diseases
Hayley B Gershengorn, Carri W Chan, Yunchao Xu, Hanxi Sun, Ronni Levy, Mor Armony, Michelle N Gong
OBJECTIVE: To understand the impact of adding a medical step-down unit (SDU) on patient outcomes and throughput in a medical intensive care unit (ICU). DESIGN: Retrospective cohort study. SETTING: Two academic tertiary care hospitals within the same health-care system. PATIENTS: Adults admitted to the medical ICU at either the control or intervention hospital from October 2013 to March 2014 (preintervention) and October 2014 to March 2015 (postintervention)...
January 1, 2018: Journal of Intensive Care Medicine
Craig M Lilly, Omar Badawi, Xinggang Liu, Gill Christine S, Ilene Harris
OBJECTIVE: To determine whether patients transfused red blood cell (RBC) products according to guideline-specified pretransfusion hemoglobin (Hb) concentrations or for other reasons were more likely to survive their intensive care unit (ICU) stay. DESIGN: An observational study of 375 478 episodes of ICU care, over 5 years, was performed with ICU survival as the primary outcome. Outcomes were analyzed as a function of pretransfusion Hb concentration for groups with distinct transfusion indications while adjusting for potential confounders...
January 1, 2018: Journal of Intensive Care Medicine
Horng-Ruey Chua, Weng-Kin Wong, Venetia Huiling Ong, Dipika Agrawal, Anantharaman Vathsala, Hui-Ming Tay, Amartya Mukhopadhyay
PURPOSE: To evaluate 1-year mortality in patients with septic acute kidney injury (AKI) and to determine association between initial AKI recovery patterns ( reversal within 5 days, beyond 5 days but recovery, or nonrecovery) and chronic kidney disease (CKD) progression. METHODS: Prospective observational study, with retrospective evaluation of initial nonconsenters, of critically ill patients with septic AKI. RESULTS: We studied 207 patients (age, mean [SD]: 64 [16] years, 39% males), of which 56 (27%), 18 (9%), and 9 (4%) died in intensive care unit (ICU), post-ICU in hospital, and posthospitalization, respectively...
January 1, 2018: Journal of Intensive Care Medicine
Luisa Flohr, Shaylene Beaudry, K Taneille Johnson, Nicholas West, Catherine M Burns, J Mark Ansermino, Guy A Dumont, David Wensley, Peter Skippen, Matthias Gorges
The pediatric intensive care unit (ICU) is a complex environment, in which a multidisciplinary team of clinicians (registered nurses, respiratory therapists, and physicians) continually observe and evaluate patient information. Data are provided by multiple, and often physically separated sources, cognitive workload is high, and team communication can be challenging. Our aim is to combine information from multiple monitoring and therapeutic devices in a mobile application, the VitalPAD , to improve the efficiency of clinical decision-making, communication, and thereby patient safety...
2018: IEEE Journal of Translational Engineering in Health and Medicine
Sandra Grace, Roger Engel, Ian Jalsion
The Australian chiropractic and osteopathic professions underwent a period of significant transformation between 1960 and 2000. This resulted in an improvement in the views held by the medical profession towards the two professions. However, a recent survey of Australian general practitioners (GPs) reported that a number of GPs still hold negative views towards chiropractors and osteopaths. This paper examines these views from the perspective of critical realism and explores the generative mechanisms that can influence the willingness of health practitioners to collaborate over patient care...
2018: Evidence-based Complementary and Alternative Medicine: ECAM
Rupert Page, Rohit Shankar, Brendan N McLean, Jane Hanna, Craig Newman
Epilepsy is associated with a significant increase in morbidity and mortality. The likelihood is significantly greater for those patients with specific risk factors. Identifying those at greatest risk of injury and providing expert management from the earliest opportunity is made more challenging by the circumstances in which many such patients present. Despite increasing recognition of the importance of earlier identification of those at risk, there is little or no improvement in outcomes over more than 30 years...
2018: Frontiers in Neurology
Ingrid Zyserman, Deboprosad Mondal, Francisco Sarabia, James H McKerrow, William R Roush, Anjan Debnath
Primary amebic meningoencephalitis (PAM) is a rapidly fatal infection caused by the free-living ameba Naegleria fowleri. PAM occurs principally in healthy children of less than 13 years old with a history of recent exposure to warm fresh water. While as yet not a reportable disease, the Centers for Disease Control and Prevention (CDC) documents a total of 143 cases in the United States. Only four patients have survived. Infection results from water containing N. fowleri entering the nose, followed by migration of the amebae to the brain...
March 15, 2018: Experimental Parasitology
Kimberly Joseph, Sameer Gupta, James Yon, Renee Partida, Lee Cartagena, John Kubasiak, Vanessa Buie, Jared Miller, Dorion Wiley, Kimberly Nagy, Frederic Starr, Andrew Dennis, Matthew Kaminsky, Faran Bokhari
BACKGROUND: Checklists have been advocated to improve quality outcomes/communication in the critical care setting, but results have been mixed. A new checklist process, "TRAUMA LIFE", was implemented in our Trauma Intensive Care Unit (TICU) to replace prior checklists. The purpose of this study was to evaluate the impact of the "TRAUMA LIFE" process implementation on quality metrics and on patient/family communication in the TICU. METHODS: "TRAUMA LIFE" was considered maturely implemented by 2016...
March 9, 2018: American Journal of Surgery
D Díaz-Díaz, M Villanova Martínez, E Palencia Herrejón
OBJECTIVE: To analyze the factors influencing in-hospital mortality among cancer patients admitted to an Intensive Care Unit (ICU). DESIGN: A retrospective observational study was carried out. SETTING: The ICU of a community hospital. PATIENTS: Adults diagnosed with solid or hematological malignancies admitted to the ICU, excluding those admitted after scheduled surgery and those with an ICU stay of under 24h. INTERVENTIONS: Review of clinical data...
March 15, 2018: Medicina Intensiva
Hannah Lee, Jae-Woo Ju, Seung-Young Oh, Jeongsoo Kim, Chul Woo Jung, Ho Geol Ryu
BACKGROUND: Recent reports suggest that not all critically ill patients with delirium share the same consequences. The outcomes of surgical intensive care unit patients with postoperative delirium were evaluated depending on the onset and duration of delirium. METHODS: A total of 527 patients who were admitted from the operating theater and cared for in the surgical intensive care unit for >24 hours were evaluated for delirium using the Confusion Assessment Method for intensive care unit, 3 times a day...
March 15, 2018: Surgery
Tiago Antonio Tonietto, Marcio Manozzo Boniatti, Thiago Costa Lisboa, Marina Verçoza Viana, Moreno Calcagnotto Dos Santos, Carla Silva Lincho, José Augusto Santos Pellegrini, Josi Vidart, Jeruza Lavanholi Neyeloff, Gustavo Adolpho Moreira Faulhaber
BACKGROUND: Red blood cell distribution width (RDW) is a predictor of mortality in critically ill patients. Our objective was to investigate the association between the RDW at ICU discharge and the risk of ICU readmission or unexpected death in the ward. METHODS: A secondary analysis of prospectively collected data study was conducted including patients discharged alive from the ICU to the ward. The target variable was the RDW collected at ICU discharge. Elevated RDW was defined as an RDW > 16%...
March 14, 2018: Clinical Biochemistry
Rosechelle M Ruggiero
The entity of chronic critical illness (CCI) has shown a rise in the past decades for popularity and prevalence. CCI is loosely defined as the group of patients who require the intensive care setting for weeks to months; its hallmark is prolonged mechanical ventilation. The outcomes of chronically critically ill patients have been dismal and have not improved over time; 1-year survival hovers at approximately 50%. Given the high mortality, prognostic variables are important when making medical decisions. CCI encompasses a syndrome that includes altered pathophysiology across a variety of organ systems...
March 2018: American Journal of the Medical Sciences
Eashaa Kumar, Michael T McCurdy, Christian A Koch, Abdurrahman Hamadah, Tibor Fülöp, Kamel A Gharaibeh
Unexplained hypotension in the intensive care unit is commonly attributed to volume depletion, cardiorespiratory failure, sepsis, or relative adrenal insufficiency. In these acute conditions, thyroid hormone levels measured in blood, serum or plasma are often altered and solely attributed to critical illness. We report a series of 3 critically ill patients with prolonged respiratory failure, suppressed mental status and unexplained hypotension. Thyroid stimulating hormone levels ranged from normal to mildly elevated (2...
March 2018: American Journal of the Medical Sciences
Alice G Vassiliou, Anastasia Kotanidou, Zafeiria Mastora, Carlo Tascini, Gianluigi Cardinali, Stylianos E Orfanos
INTRODUCTION: A soluble (s) form of the endothelial protein C receptor (EPCR) circulates in plasma and inhibits activated protein C (APC) activities. The clinical impact of sEPCR and its involvement in the septic process is under investigation. This study determined the frequencies of EPCR haplotypes H1 and H3 to investigate possible associations with plasma admission levels of sEPCR in an intensive care unit (ICU) cohort of septic patients. METHODS: Three polymorphisms in the EPCR gene were genotyped in 239 Caucasian critically ill patients, and their plasma sEPCR levels were also measured at the time of admission to the ICU...
March 2018: Infectious Diseases and Therapy
Mårten Unnerbäck, Eric L Bloomfield, Sven Söderström, Peter Reinstrup
Current methods to measure cerebral blood flow (CBF) in the neuro critical care setting cannot monitor the CBF continuously. In contrast, continuous measurement of intracranial pressure (ICP) is readily accomplished, and there is a component of ICP that correlates with arterial inflow of blood into the cranial cavity. This property may have utility in using continuous ICP curve analysis to continuously estimate CBF. We examined the data from 13 patients, monitored with an intraventricular ICP device determining the pulsatile amplitude ICPamp as well as the area under the ICP curve (AUCICP )...
March 16, 2018: Journal of Clinical Monitoring and Computing
Mohanned Mustafa, Easwaradhas Gladston Chelliah, Michael Hughes
Patients with systemic rheumatic diseases (SRDs) may require admission to the intensive care unit (ICU) throughout the course of their disease. Therefore, the rheumatologist needs an understanding of the factors which may influence the course of patients with SRDs who are admitted to ICU. These include the causes for admission, patient characteristics including comorbidities and drug therapies, outcome (in-ICU mortality and causes of death), and prognostic factors. Infections and exacerbation/complications of SRDs are the most common (and potentially reversible) reasons for both admission and death on ICU...
March 16, 2018: Rheumatology International
Adam J Camblin, Emily A Pace, Sharlene Adams, Michael D Curley, Victoria Rimkunas, Lin Nie, Gege Tan, Troy Bloom, Sergio Iadevaia, Jason Baum, Charlene Minx, Akos Czibere, Chrystal U Louis, Daryl C Drummond, Ulrik B Nielsen, Birgit Schoeberl, J Marc Pipas, Robert M Straubinger, Vasileios Askoxylakis, Alexey A Lugovskoy
PURPOSE: Insulin-like growth factor receptor 1 (IGF-1R) is critically involved in pancreatic cancer pathophysiology, promoting cancer cell survival and therapeutic resistance. Assessment of IGF-1R inhibitors in combination with standard-of-care chemotherapy, however, failed to demonstrate significant clinical benefit. The aim of this work is to unravel mechanisms of resistance to IGF-1R inhibition in pancreatic cancer and develop novel strategies to improve the activity of standard-of-care therapies...
March 16, 2018: Clinical Cancer Research: An Official Journal of the American Association for Cancer Research
Shannon M Fernando, Douglas P Barnaby, Christophe L Herry, E John Gallagher, Nathan I Shapiro, Andrew J E Seely
BACKGROUND: Early emergency department (ED) identification of septic patients at risk of deterioration is critical. Lactate is associated with 28-day mortality in admitted patients, but little evidence exists on its use in predicting short-term deterioration. OBJECTIVE: Our aim was to determine the role of initial serum lactate for prediction of short-term deterioration in stable ED patients with suspected sepsis. METHODS: We conducted a prospective cohort study of adult ED sepsis patients...
March 13, 2018: Journal of Emergency Medicine
Michaela K Nichols, Melissa K Andrew, Todd F Hatchette, Ardith Ambrose, Guy Boivin, William Bowie, Ayman Chit, Gael Dos Santos, May ElSherif, Karen Green, Francois Haguinet, Scott A Halperin, Barbara Ibarguchi, Jennie Johnstone, Kevin Katz, Phillipe Lagacé-Wiens, Joanne M Langley, Jason LeBlanc, Mark Loeb, Donna MacKinnon-Cameron, Anne McCarthy, Janet E McElhaney, Allison McGeer, Andre Poirier, Jeff Powis, David Richardson, Anne Schuind, Makeda Semret, Vivek Shinde, Stephanie Smith, Daniel Smyth, Grant Stiver, Geoffrey Taylor, Sylvie Trottier, Louis Valiquette, Duncan Webster, Lingyun Ye, Shelly A McNeil
BACKGROUND: Ongoing assessment of influenza vaccine effectiveness (VE) is critical to inform public health policy. This study aimed to determine the VE of trivalent influenza vaccine (TIV) for preventing influenza-related hospitalizations and other serious outcomes over three consecutive influenza seasons. METHODS: The Serious Outcomes Surveillance (SOS) Network of the Canadian Immunization Research Network (CIRN) conducted active surveillance for influenza in adults ≥16 years (y) of age during the 2011/2012, 2012/2013 and 2013/2014 seasons in hospitals across Canada...
March 13, 2018: Vaccine
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