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https://www.readbyqxmd.com/read/28445858/the-impact-of-minor-blood-transfusion-on-the-outcome-after-coronary-artery-bypass-grafting
#1
Eeva-Maija Kinnunen, Marco Zanobini, Francesco Onorati, Debora Brascia, Giovanni Mariscalco, Ilaria Franzese, Vito G Ruggieri, Karl Bounader, Andrea Perrotti, Francesco Musumeci, Giuseppe Santarpino, Daniele Maselli, Saverio Nardella, Helmut Gulbins, Riccardo Gherli, Antonino S Rubino, Carmelo Mignosa, Marisa De Feo, Giuseppe Gatti, Francesco Santini, Antonio Salsano, Magnus Dalén, Matteo Saccocci, Daniel Reichart, Giuseppe Faggian, Tiziano Gherli, Francesco Nicolini, Fausto Biancari
PURPOSE: To investigate the impact of minor perioperative bleeding requiring transfusion of 1-2 red blood cell (RBC) units on the outcome after coronary artery bypass grafting (CABG). METHODS: Sixteen cardiac surgical centers contributed to the prospective European CABG registry (E-CABG). 1014 patients receiving 1-2 RBC units during or after isolated CABG were compared to 2264 patients not receiving RBCs. RESULTS: In 827 propensity score matched pairs, transfusion of 1-2 RBC units did not affect the risk of in-hospital/30-day death (p=0...
April 19, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28430992/identifying-practice-related-factors-for-high-volume-prescribers-of-antibiotics-in-danish-general-practice
#2
Rune Aabenhus, Volkert Siersma, Håkon Sandholdt, Rasmus Køster-Rasmussen, Malene Plejdrup Hansen, Lars Bjerrum
Objectives: In Denmark, general practice is responsible for 75% of antibiotic prescribing in the primary care sector. We aimed to identify practice-related factors associated with high prescribers, including prescribers of critically important antibiotics as defined by WHO, after accounting for case mix by practice. Methods: We performed a nationwide register-based survey of antibiotic prescribing in Danish general practice from 2012 to 2013. The unit of analysis was the individual practice...
April 19, 2017: Journal of Antimicrobial Chemotherapy
https://www.readbyqxmd.com/read/28428012/-retrospective-study-of-children-referred-from-paediatric-intensive-care-to-palliative-care-why-and-for-what
#3
Alberto García-Salido, Paula Santos-Herranz, Verónica Puertas-Martín, María Ángeles García-Teresa, Ricardo Martino-Alba, Ana Serrano-González
INTRODUCTION: The creation of paediatric palliative care units (PPCU) could optimise the management of children with palliative focus after admission to a paediatric intensive care unit (PICU). This study describes the clinical and epidemiological characteristics of children referred from PICU to the UCPP of the Autonomous Community of Madrid (CAM). The overall treatment, relapses, re-admissions, and deaths, if occurred, are described. PATIENTS AND METHOD: A retrospective review was performed using the medical records from children transferred from the CAM paediatric intensive care units to the paediatric palliative care unit (1 March 2008-31 January 2015)...
April 17, 2017: Anales de Pediatría: Publicación Oficial de la Asociación Española de Pediatría (A.E.P.)
https://www.readbyqxmd.com/read/28413520/prognosis-of-patients-with-acinetobacter-baumannii-infection-in-the-intensive-care-unit-a-retrospective-analysis
#4
Dong Xiao, Lu Wang, Daquan Zhang, Dongming Xiang, Qi Liu, Xuezhong Xing
The present retrospective study aimed to investigate the prognostic factors for critically ill patients with an Acinetobacter baumannii (A. baumannii) infection. A total of 37 patients from the intensive care unit (ICU) were enrolled in the study. Data was collected from patients, including age, gender, ethnicity, A. baumannii infection status, concurrent infection status, prescribed antibiotics, Acute Physiology and Chronic Health Evaluation II (APACHE II) and sepsis-related organ failure assessment (SOFA) scores, procalcitonin level, site of infection, shock, sepsis and renal replacement therapy status...
April 2017: Experimental and Therapeutic Medicine
https://www.readbyqxmd.com/read/28409203/the-role-of-infection-models-and-pk-pd-modelling-for-optimising-care-of-critically-ill-patients-with-severe-infections
#5
REVIEW
T Tängdén, V Ramos Martín, T W Felton, E I Nielsen, S Marchand, R J Brüggemann, J B Bulitta, M Bassetti, U Theuretzbacher, B T Tsuji, D W Wareham, L E Friberg, J J De Waele, V H Tam, Jason A Roberts
Critically ill patients with severe infections are at high risk of suboptimal antimicrobial dosing. The pharmacokinetics (PK) and pharmacodynamics (PD) of antimicrobials in these patients differ significantly from the patient groups from whose data the conventional dosing regimens were developed. Use of such regimens often results in inadequate antimicrobial concentrations at the site of infection and is associated with poor patient outcomes. In this article, we describe the potential of in vitro and in vivo infection models, clinical pharmacokinetic data and pharmacokinetic/pharmacodynamic models to guide the design of more effective antimicrobial dosing regimens...
April 13, 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28400686/convergence-of-minds-for-better-patient-outcome-in-intensive-care-unit-infections
#6
Chand Wattal, Yash Javeri, Neeraj Goel, Debashish Dhar, Sonal Saxena, Sarman Singh, Jaswinder Kaur Oberoi, B K Rao, Purva Mathur, Vikas Manchanda, Vivek Nangia, Arti Kapil, Ashok Rattan, Supradip Ghosh, Omender Singh, Vinod Singh, Iqbal Kaur, Sanghamitra Datta, Sharmila Sen Gupta
BACKGROUND: There is emergence of resistance to the last-line antibiotics such as carbapenems in Intensive Care Units (ICUs), leaving little effective therapeutic options. Since there are no more newer antibiotics in the armamentarium in the near future, it has become imperative that we harness the interdisciplinary knowledge for the best clinical outcome of the patient. AIMS: The aim of the conference was to utilize the synergies between the clinical microbiologists and critical care specialists for better patient care and clinical outcome...
March 2017: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28396656/prescription-patterns-for-tigecycline-in-severely-ill-patients-for-non-fda-approved-indications-in-a-developing-country-a-compromised-outcome
#7
Rima A Moghnieh, Dania I Abdallah, Ismail A Fawaz, Tarek Hamandi, Mohammad Kassem, Nabila El-Rajab, Tamima Jisr, Anas Mugharbil, Nabila Droubi, Samaa Al Tabah, Loubna Sinno, Fouad Ziade, Ziad Daoud, Ahmad Ibrahim
Introduction: With the rise in antibiotic resistance, tigecycline has been used frequently in off-label indications, based on its in-vitro activity against multidrug-resistant organisms. In this study, our aim was to assess its use in approved and unapproved indications. Materials and Methods: This is a retrospective chart review evaluating a 2-year experience of tigecycline use for > 72 h in 153 adult patients inside and outside critical care unit from January 2012 to December 2013 in a Lebanese tertiary-care hospital...
2017: Frontiers in Microbiology
https://www.readbyqxmd.com/read/28384858/antimicrobial-resistance-surveillance-among-intensive-care-units-of-a-tertiary-care-hospital-in-southern-india
#8
Kailash Moolchandani, Apurba Sankar Sastry, R Deepashree, Sujatha Sistla, B N Harish, Jharna Mandal
INTRODUCTION: Hospital Acquired Infections (HAIs) are the rising threat in the health care facilities across the globe. As most Intesive Care Unit (ICU) patients are frequently on broad spectrum antimicrobials, this induces selective antibiotic pressure which leads to development of Antimicrobial Resistance (AMR) among the microorganisms of ICUs. AIM: To study the occurrence of different types of HAIs in patients admitted to various ICUs of JIPMER and the AMR pattern of the bacterial pathogens isolated from them...
February 2017: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/28379911/treatment-of-pregnant-patients-with-orthopaedic-trauma
#9
Nirmal Tejwani, Kevin Klifto, Christopher Looze, Christopher Scott Klifto
Fracture management in pregnant patients is challenging. Anatomic and physiologic changes in pregnancy increase the complexity of treatment. Maternal trauma increases the risk of fetal loss, preterm birth, placental abruption, cesarean delivery, and maternal death. Initial resuscitation and treatment in a facility equipped to handle the orthopaedic injury and preterm births are paramount. Pelvic and acetabular injuries are potentially life threatening. The benefits and risks of surgical treatment must be carefully considered...
May 2017: Journal of the American Academy of Orthopaedic Surgeons
https://www.readbyqxmd.com/read/28376885/citrobacter-braakii-bacteremia-induced-septic-shock-after-colonoscopy-preparation-with-polyethylene-glycol-in-a-critically-ill-patient-a-case-report
#10
Tetsuya Yumoto, Yoshiyasu Kono, Seiji Kawano, Chihiro Kamoi, Atsuyoshi Iida, Motoko Nose, Keiji Sato, Toyomu Ugawa, Hiroyuki Okada, Yoshihito Ujike, Atsunori Nakao
BACKGROUND: Polyethylene glycol (PEG) is widely used for bowel cleaning in preparation for colonoscopy because of its safety. Septic shock after PEG preparation is an extremely rare complication. Herein, we describe a case of septic shock that occurred immediately after colonoscopy preparation with PEG. CASE PRESENTATION: A 75-year-old Japanese male who had previously developed diabetes after total pancreatectomy received PEG in preparation for colonoscopy. He had been admitted to the emergency intensive care unit 4 days earlier due to hematochezia presenting with shock...
April 4, 2017: Annals of Clinical Microbiology and Antimicrobials
https://www.readbyqxmd.com/read/28373096/metabolic-profiling-in-patients-with-pneumonia-on-intensive-care
#11
David Antcliffe, Beatriz Jiménez, Kirill Veselkov, Elaine Holmes, Anthony C Gordon
Clinical features and investigations lack predictive value when diagnosing pneumonia, especially when patients are ventilated and when patients develop ventilator associated pneumonia (VAP). New tools to aid diagnosis are important to improve outcomes. This pilot study examines the potential for metabolic profiling to aid the diagnosis in critical care. In this prospective observational study ventilated patients with brain injuries or pneumonia were recruited in the intensive care unit and serum samples were collected soon after the start of ventilation...
March 29, 2017: EBioMedicine
https://www.readbyqxmd.com/read/28363592/a-survey-of-critical-care-nurses-practices-and-perceptions-surrounding-early-intravenous-antibiotic-initiation-during-septic-shock
#12
Russel J Roberts, Abdullah M Alhammad, Lindsay Crossley, Eric Anketell, LeeAnn Wood, Greg Schumaker, Erik Garpestad, John W Devlin
BACKGROUND: Delays in antibiotic administration after severe sepsis recognition increases mortality. While physician and pharmacy-related barriers to early antibiotic initiation have been well evaluated, those factors that affect the speed by which critical care nurses working in either the emergency department or the intensive care unit setting initiate antibiotic therapy remains poorly characterized. AIM: To evaluate the knowledge, practices and perceptions of critical care nurses regarding antibiotic initiation in patients with newly recognised septic shock...
March 28, 2017: Intensive & Critical Care Nursing: the Official Journal of the British Association of Critical Care Nurses
https://www.readbyqxmd.com/read/28353418/factors-associated-with-the-development-of-tertiary-peritonitis-in-critically-ill-patients
#13
Josep Ballus, Juan C Lopez-Delgado, Joan Sabater-Riera, Xose L Perez-Fernandez, Antoni J Betbese, Joan A Roncal
BACKGROUND: Critically ill surgical patients remain at a high risk of adverse outcomes as a result of secondary peritonitis (SP). The risk is even higher if tertiary peritonitis (TP) develops. Factors related to the development of TP, however, are scarce in the literature. The main aim of our study was to identify factors associated with the development of TP in patients with SP in the intensive care unit (ICU), and also to report differences in microbiologic patterns and antibiotic therapy in patients with the two conditions...
March 29, 2017: Surgical Infections
https://www.readbyqxmd.com/read/28350942/prevention-of-surgical-site-infection-in-spine-surgery
#14
Paul A Anderson, Jason W Savage, Alexander R Vaccaro, Kristen Radcliff, Paul M Arnold, Brandon D Lawrence, Mohammed F Shamji
BACKGROUND: Spine surgery is complicated by an incidence of 1% to 9% of surgical site infection (SSI). The most common organisms are gram-positive bacteria and are endogenous, that is are brought to the hospital by the patient. Efforts to improve safety have been focused on reducing SSI using a bundle approach. The bundle approach applies many quality improvement efforts and has been shown to reduce SSI in other surgical procedures. OBJECTIVE: To provide a narrative review of practical solutions to reduce SSI in spine surgery...
March 1, 2017: Neurosurgery
https://www.readbyqxmd.com/read/28342609/randomized-blinded-controlled-clinical-trial-shows-no-benefit-of-homeopathic-mastitis-treatment-in-dairy-cows
#15
Fanny Ebert, Rudolf Staufenbiel, Julia Simons, Laura Pieper
Mastitis is one of the most common diseases in dairy production, and homeopathic remedies have been used increasingly in recent years to treat it. Clinical trials evaluating homeopathy have often been criticized for their inadequate scientific approach. The objective of this triple-blind, randomized controlled trial was to assess the efficacy of homeopathic treatment in bovine clinical mastitis. The study was conducted on a conventionally managed dairy farm between June 2013 and May 2014. Dairy cows with acute mastitis were randomly allocated to homeopathy (n = 70) or placebo (n = 92), for a total of 162 animals...
March 22, 2017: Journal of Dairy Science
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
#16
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/28330460/sepsis-recognition-in-the-emergency-department-impact-on-quality-of-care-and-outcome
#17
Marius Morr, Alexander Lukasz, Eva Rübig, Hermann Pavenstädt, Philipp Kümpers
BACKGROUND: Appropriate and timely recognition of sepsis is a prerequisite for starting goal-directed therapy bundles. We analyzed the appropriateness of sepsis recognition and documentation with regard to adequacy of therapy and outcome in an internal medicine emergency department (ED). METHODS: This study included 487 consecutive patients ≥18 years of age who presented to a university hospital ED during a 4-week period. Clinical, laboratory, and follow-up data were acquired independently from documentation by ED physicians...
March 23, 2017: BMC Emergency Medicine
https://www.readbyqxmd.com/read/28329238/practice-patterns-and-outcomes-associated-with-procalcitonin-use-in-critically-ill-patients-with-sepsis
#18
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
#19
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/28298480/antimicrobial-stewardship-programmes-bedside-rationing-by-another-name
#20
Simon Oczkowski
Antimicrobial therapy is a cornerstone of therapy in critically ill patients; however, the wide use of antibiotics has resulted in increased antimicrobial resistance and outbreaks of resistant disease. To counter this, many hospitals have instituted antimicrobial stewardship programmes as a way to reduce the inappropriate use of antibiotics. However, uptake of antimicrobial stewardship programmes has been variable, as many clinicians fear that they may put individual patients at risk of treatment failure. In this paper, I argue that antimicrobial stewardship programmes are indeed a form of bedside rationing, and explore the risks and benefits of such programmes for individual patients in the intensive care unit, and the critically ill population in general...
March 15, 2017: Journal of Medical Ethics
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