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new trends in icu management's

Chien-Ming Chao, Chih-Cheng Lai, Khee-Siang Chan, Kuo-Chen Cheng, Chung-Han Ho, Chin-Ming Chen, Willy Chou
We conduct a retrospective study of patients with unplanned extubation (UE) in adult intensive care units (ICU) at a medical center. In 2001, a multidisciplinary team of intensivists, senior residents, nurses, and respiratory therapists was established at Chi Mei Medical Center. The improvement interventions, implemented between 2001 and 2015, were organized around 8 key areas: standardizing procedures, improving communication skills, revising sedation and weaning protocols, changing strategies for restraints, establishing a task force for identifying and managing high-risk patients, using new quality-improvement models as breakthrough series and team resource management, using the strategy of accountability without assigning blame, and changing a new method to secure endotracheal tube...
July 2017: Medicine (Baltimore)
S Loudin, J Werthammer, L Prunty, S Murray, J I Shapiro, T H Davies
OBJECTIVE: The purpose of this study was to test a specialized needs-based management model for a high volume of babies born with neonatal abstinence syndrome (NAS) while controlling costs and reducing neonatal intensive care unit (NICU) bed usage. STUDY DESIGN: Data were analyzed from inborn neonates >35 weeks' gestational age with the diagnosis of NAS (ICD9-CM 779.5), requiring pharmacologic treatment and discharged from 2010 through 2015. Significance was determined using Kruskal-Wallis and Mann-Whitney as well as χ(2) for trend...
July 6, 2017: Journal of Perinatology: Official Journal of the California Perinatal Association
Sanjit R Konda, Ariana Lott, Arthur Manoli, Karan Patel, Kenneth A Egol
OBJECTIVE: To compare the cost and outcomes of patients treated at orthopaedic teaching hospitals (OTH) compared to those treated at non-teaching hospitals (NTH) DESIGN:: Retrospective study SETTING:: The Statewide Planning and Research Cooperative Systems (SPARCS) database, which includes all admissions to New York State hospitals from 2000-2011. PATIENTS/PARTICIPANTS: 165,679 isolated closed hip fracture patients aged 65 and older met inclusion criteria. Of these, 57,279 were treated at OTH and 108,400 were treated at NTH...
June 12, 2017: Journal of Orthopaedic Trauma
Ekaterina A Kletsova, Eric D Spitzer, Bettina C Fries, Luis A Marcos
BACKGROUND: Babesiosis is a potentially life-threatening, tick-borne infection endemic in New York. The purpose of this study was to review recent trends in babesiosis management and outcomes focusing on patients, who were treated with combination of azithromycin and atovaquone. METHODS: A retrospective chart review of patients seen at Stony Brook University Hospital between 2008 and 2014 with peripheral blood smears positive for Babesia was performed. Clinical and epidemiological information was recorded and analyzed...
April 11, 2017: Annals of Clinical Microbiology and Antimicrobials
Mio Ozawa, Kyoko Yokoo, Yuuki Funaba, Sayo Fukushima, Rie Fukuhara, Mieko Uchida, Satoru Aiba, Miki Doi, Akira Nishimura, Masahiro Hayakawa, Yutaka Nishimura, Mitsuko Oohira
BACKGROUND: Neonatal pain management guidelines have been released; however, there is insufficient systematic institutional support for the adoption of evidence-based pain management in Japan. PURPOSE: To evaluate the impact of a collaborative quality improvement program on the implementation of pain management improvements in Japanese neonatal intensive care units (NICUs). METHODS: Seven Japanese level III NICUs participated in a neonatal pain management quality improvement program based on an Institute for Healthcare Improvement collaborative model...
June 2017: Advances in Neonatal Care: Official Journal of the National Association of Neonatal Nurses
Roberto Cirocchi, Arianna Birindelli, Walter L Biffl, Ventsislav Mutafchiyski, Georgi Popivanov, Osvaldo Chiara, Gregorio Tugnoli, Salomone Di Saverio
BACKGROUND: The open abdomen technique may be used in critically ill patients to manage abdominal injury, reduce the septic complications, and prevent the abdominal compartment syndrome. Many different techniques have been proposed and multiple studies have been conducted, but the best method of temporary abdominal closure has not been determined yet. Recently, new randomized and nonrandomized controlled trials have been published on this topic. We aimed to perform an up-to-date systematic review on the management of open abdomen, including the most recent published randomized and nonrandomized controlled trials, to compare negative pressure wound therapy (NPWT) with no NPWT and define if one technique has better outcomes than the other with regard to primary fascial closure, postoperative 30-day mortality and morbidity, enteroatmospheric fistulae, abdominal abscess, bleeding, and length of stay...
September 2016: Journal of Trauma and Acute Care Surgery
Jyoti M Benni, Paragouda A Patil
BACKGROUND: Introducing a new drug to the market is a time-consuming process, is complex, and involves consumption of a lot of resources. Therefore, discovering new uses for the old drugs (i.e. drug repurposing) benefits the patients by providing them time-tested drugs. With developments in insulin therapy still happening, it is worth keeping up to date on trends in the use of this powerful glucose-lowering agent. The aim of this article is to explore the potential non-diabetic clinical applications of insulin...
September 1, 2016: Journal of Basic and Clinical Physiology and Pharmacology
Ryan Wiatrowski, Colleen Norton, David Giffen
Sedation practices in the critical care unit have been trending toward lighter sedation since the start of the new millennium, but patients continue to experience inadequate pain management and excessive sedation. This paper includes a brief examination of the problem of pain management in the ICU; trends in sedation practices, including light sedation and the daily interruption of sedation; and a literature review of analgosedation. While the analgosedation literature is relatively sparse, it offers a promising, patient-centered method for managing the triad of pain, agitation, and delirium, while reducing common complications associated with long-term ventilation...
June 2016: Pain Management Nursing: Official Journal of the American Society of Pain Management Nurses
Lavi Oud
BACKGROUND: There are mixed findings on the longitudinal patterns of the incidence of intensive care unit (ICU)-managed candidemia, with scarcity of reports on the corresponding evolving patterns of patients' clinical characteristics and outcomes. No population-level data were reported on the temporal trends of the attributes, care and outcomes of ICU-managed adults with candidemia. METHODS: The Texas Inpatient Public Use Data File was used to identify hospitalizations aged 18 years or older with a diagnosis of candidemia and ICU admission (C-ICU hospitalizations) between 2001 and 2010...
April 2016: Journal of Clinical Medicine Research
Brooke Read, David Sc Lee, Debbie Fraser
BACKGROUND: The use of mechanical ventilation to treat respiratory distress syndrome in preterm infants has been associated with the development of bronchopulmonary dysplasia. As part of a quality improvement initiative to reduce the incidence of bronchopulmonary dysplasia in preterm infants, a new practice guideline for the management of respiratory distress syndrome was developed and adopted into practice in a neonatal intensive care unit in February 2012. OBJECTIVE: To evaluate the effects of implementing the new guideline in regard to the use of mechanical ventilation and surfactant, and the incidence of bronchopulmonary dypslasia...
January 2016: Paediatrics & Child Health
Shruti Agrawal, Ricardo Garcia Branco
Traumatic brain injury (TBI) is a major cause of death and disability in children. Severe TBI is a leading cause of death and often leads to life changing disabilities in survivors. The modern management of severe TBI in children on intensive care unit focuses on preventing secondary brain injury to improve outcome. Standard neuroprotective measures are based on management of intracranial pressure (ICP) and cerebral perfusion pressure (CPP) to optimize the cerebral blood flow and oxygenation, with the intention to avoid and minimise secondary brain injury...
February 4, 2016: World Journal of Critical Care Medicine
Gaël Le Roux, Chloé Bruneau, Bénédicte Lelièvre, Marie Bretaudeau Deguigne, Alain Turcant, Patrick Harry, David Boels
OBJECTIVES: Over the last decade, use of phenethylamines has become increasingly prevalent. This study aimed to describe typical aspects of phenethylamine poisoning in order to better inform patient care. METHODS: Phenethylamine poisoning cases reported to the Poison Control Center of Angers, France, from January, 2007 to December, 2013 were examined. Clinical findings were examined in 105 patients, including phenethylamine used, symptoms and final outcome. Patients were predominantly male (80%), with mean age 26±8 years...
September 1, 2015: Drug and Alcohol Dependence
Giovanni Alemanno, Carlo Bergamini, Jacopo Martellucci, Riccardo Somigli, Paolo Prosperi, Alessandro Bruscino, Alessandro Sturiale, Andrea Valeri
BACKGROUND: More recently mortality and morbidity related to PD has dramatically dropped, due to the new mini-invasive technology as well as to a trend leading towards centralization. Our hospital can be considered a high-volume center for pancreatic surgery; nevertheless, each of its 5 surgical units taken alone has a low/medium-volume activity. The aim of this study was to evaluate the results of PD in a low-medium volume unit with multidisciplinary support in a major high-volume hospital...
February 2016: Minerva Chirurgica
Solomon Aronson, Joseph F Dasta, Jerrold H Levy, Philip D Lumb, Manuel Fontes, Yamei Wang, Tracy A Crothers, Katherine A Sulham, Marco S Navetta
OBJECTIVE: To examine the impact of intravenous antihypertensive selection on hospital health resource utilization using data from the Evaluation of CLevidipine In the Perioperative Treatment of Hypertension Assessing Safety Events (ECLIPSE) trials. METHODS: Analysis of ECLIPSE trial data comparing clevidipine to nitroglycerin, sodium nitroprusside, and nicardipine and unit costs based on the Premier Hospital database to assess surgery duration, time to extubation, and length of stay (LOS) with the associated cost...
August 2014: Hospital Practice (Minneapolis)
Steven A Trankle
BACKGROUND: In Australia approximately 70% of all deaths are institutionalised but over 15% of deaths occur in intensive care settings where the ability to provide a "good death" is particularly inhibited. Yet, there is a growing trend for death and dying to be managed in the ICU and physicians are increasingly challenged to meet the new expectations of their specialty. This study examined the unexplored interface between specialised Australian palliative and intensive care and the factors influencing a physician's ability to manage deaths well...
2014: BMC Palliative Care
Seniha Senbayrak Akcay, Asuman Inan, Simin Cevan, Ayse Nilufer Ozaydın, Naz Cobanoglu, Seyfi Celik Ozyurek, Sebahat Aksaray
INTRODUCTION: This study aimed to demonstrate the changing epidemiology of infecting microorganisms and their long-term resistance profiles and to describe the microbiological point of view in anti-infective management of intensive care unit (ICU) patients. METHODOLOGY: A total of 5,690 isolates of Gram-negative bacilli were included in this study. Antibiotic susceptibility was tested using the disk diffusion method and Vitek 2 system. Chi-square tests were used for hypothesis testing...
May 2014: Journal of Infection in Developing Countries
Felicity Thomas, Christopher G Pretty, Liam Fisk, Geoffrey M Shaw, J Geoffrey Chase, Thomas Desaive
BACKGROUND: The metabolism of critically ill patients evolves dynamically over time. Post critical insult, levels of counter-regulatory hormones are significantly elevated, but decrease rapidly over the first 12-48 hours in the intensive care unit (ICU). These hormones have a direct physiological impact on insulin sensitivity (SI). Understanding the variability of SI is important for safely managing glycaemic levels and understanding the evolution of patient condition. The objective of this study is to assess the evolution of SI over the first two days of ICU stay, and using this data, propose a separate stochastic model to reduce the impact of SI variability during glycaemic control using the STAR glycaemic control protocol...
2014: Biomedical Engineering Online
Salomone Di Saverio, Giorgio Gambale, Federico Coccolini, Fausto Catena, Eleonora Giorgini, Luca Ansaloni, Niki Amadori, Carlo Coniglio, Aimone Giugni, Andrea Biscardi, Stefano Magnone, Filippo Filicori, Piergiorgio Cavallo, Silvia Villani, Francesco Cinquantini, Massimo Annicchiarico, Giovanni Gordini, Gregorio Tugnoli
BACKGROUND: Our experience in trauma center management increased over time and improved with development of better logistics, optimization of structural and technical resources. In addition recent Government policy in safety regulations for road traffic accident (RTA) prevention, such compulsory helmet use (2000) and seatbelt restraint (2003) were issued with aim of decreasing mortality rate for trauma. INTRODUCTION: The evaluation of their influence on mortality during the last 15 years can lead to further improvements...
January 2014: Langenbeck's Archives of Surgery
François Barbier, Antoine Andremont, Michel Wolff, Lila Bouadma
PURPOSE OF REVIEW: The recent evidence is reviewed on clinical epidemiology, trends in bacterial resistance, diagnostic tools and therapeutic options in hospital-acquired pneumonia (HAP), with a special focus on ventilator-associated pneumonia (VAP). RECENT FINDINGS: The current incidence of VAP ranges from two to 16 episodes for 1000 ventilator-days, with an attributable mortality of 3-17%. Staphylococcus aureus (with 50-80% of methicillin-resistant strains), Pseudomonas aeruginosa and Enterobacteriaceae represent the most frequent pathogens in HAP/VAP...
May 2013: Current Opinion in Pulmonary Medicine
Lene Hjerrild Iversen
This thesis has reported survival among Danish colorectal cancer patients over the past decades and it has explored different aspects of the inferior short-term and long-term survival of Danish patients in relation to (i) patient factors: old age and comorbidity; (ii) disease factors: prognostic factors for early death after emergency surgery; (iii) diagnostic factors: impact of diagnostic delay; (iv) treatment factors: seasonal variation in postoperative mortality and the benefit of a new approach for management of obstructive cancer; and (v) structural factors: hospital volume and surgeon characteristics...
April 2012: Danish Medical Journal
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