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https://www.readbyqxmd.com/read/29341032/-epidemiology-diagnosis-and-treatment-of-adult-patients-with-nosocomial-pneumonia-update-2017-s3-guideline-of-the-german-society-for-anaesthesiology-and-intensive-care-medicine-the-german-society-for-infectious-diseases-the-german-society-for-hygiene-and-microbiology
#1
K Dalhoff, M Abele-Horn, S Andreas, M Deja, S Ewig, P Gastmeier, S Gatermann, H Gerlach, B Grabein, C P Heußel, G Höffken, M Kolditz, E Kramme, H Kühl, C Lange, K Mayer, I Nachtigall, M Panning, M Pletz, P-M Rath, G Rohde, S Rosseau, B Schaaf, D Schreiter, H Schütte, H Seifert, C Spies, T Welte
Nosocomial pneumonia (HAP) is a frequent complication of hospital care. Most data are available on ventilator-associated pneumonia. However, infections on general wards are increasing. A central issue are infections with multidrug resistant (MDR) pathogens which are difficult to treat in the empirical setting potentially leading to inappropriate use of antimicrobial therapy.This guideline update was compiled by an interdisciplinary group on the basis of a systematic literature review. Recommendations are made according to GRADE giving guidance for the diagnosis and treatment of HAP on the basis of quality of evidence and benefit/risk ratio...
January 2018: Pneumologie
https://www.readbyqxmd.com/read/29329913/predicting-extubation-outcomes-a-model-incorporating-heart-rate-characteristics-index
#2
Nitin Goel, Mallinath Chakraborty, William John Watkins, Sujoy Banerjee
OBJECTIVE: To test the hypothesis that in neonates on mechanical ventilation, heart rate characteristics index (HRCi) can be combined with a clinical model for predicting extubation outcomes in neonates. STUDY DESIGN: HRCi and clinical data for all intended intubation-extubation events (episodes) were retrospectively analyzed between June 2014 and January 2015. Each episode started 6 hours pre-extubation or at the time of primary intubation if ventilation duration was shorter than 6 hours (baseline)...
January 10, 2018: Journal of Pediatrics
https://www.readbyqxmd.com/read/29325753/induced-hypothermia-in-patients-with-septic-shock-and-respiratory-failure-cass-a-randomised-controlled-open-label-trial
#3
Theis Skovsgaard Itenov, Maria Egede Johansen, Morten Bestle, Katrin Thormar, Lars Hein, Louise Gyldensted, Anne Lindhardt, Henrik Christensen, Stine Estrup, Henrik Planck Pedersen, Matthew Harmon, Uday Kant Soni, Silvia Perez-Protto, Nicolai Wesche, Ulrik Skram, John Asger Petersen, Thomas Mohr, Tina Waldau, Lone Musaeus Poulsen, Ditte Strange, Nicole P Juffermans, Daniel I Sessler, Else Tønnesen, Kirsten Møller, Dennis Karsten Kristensen, Alessandro Cozzi-Lepri, Jens D Lundgren, Jens-Ulrik Jensen
BACKGROUND: Animal models of serious infection suggest that 24 h of induced hypothermia improves circulatory and respiratory function and reduces mortality. We tested the hypothesis that a reduction of core temperature to 32-34°C attenuates organ dysfunction and reduces mortality in ventilator-dependent patients with septic shock. METHODS: In this randomised, controlled, open-label trial, we recruited patients from ten intensive care units (ICUs) in three countries in Europe and North America...
January 8, 2018: Lancet Respiratory Medicine
https://www.readbyqxmd.com/read/29315332/clinical-profile-and-outcomes-of-acute-cardiorenal-syndrome-type-5-in-sepsis-an-eight-year-cohort-study
#4
Saraschandra Vallabhajosyula, Ankit Sakhuja, Jeffrey B Geske, Mukesh Kumar, Rahul Kashyap, Kianoush Kashani, Jacob C Jentzer
BACKGROUND: To evaluate the clinical features and outcomes of acute cardiorenal syndrome type-5 in patients with severe sepsis and septic shock. METHODS: Historical cohort study of all adult patients with severe sepsis and septic shock admitted to the intensive care units (ICU) at Mayo Clinic Rochester from January 1, 2007 through December 31, 2014. Patients with prior renal or cardiac dysfunction were excluded. Patients were divided into groups with and without cardiorenal syndrome type-5...
2018: PloS One
https://www.readbyqxmd.com/read/29315320/association-of-day-4-cumulative-fluid-balance-with-mortality-in-critically-ill-patients-with-influenza-a-multicenter-retrospective-cohort-study-in-taiwan
#5
Wen-Cheng Chao, Chien-Hua Tseng, Ying-Chun Chien, Chau-Chyun Sheu, Ming-Ju Tsai, Wen-Feng Fang, Yu-Mu Chen, Kuo-Chin Kao, Han-Chung Hu, Wann-Cherng Perng, Kuang-Yao Yang, Wei-Chih Chen, Shinn-Jye Liang, Chieh-Liang Wu, Hao-Chien Wang, Ming-Cheng Chan
BACKGROUND: Fluid balance is a fundamental management of patients with sepsis, and this study aimed to investigate the impact of cumulative fluid balance on critically ill patients with influenza admitted to an intensive care unit (ICU). METHODS: This multicenter retrospective cohort study was conducted by the Taiwan Severe Influenza Research Consortium (TSIRC) which includes eight medical centers. Patients with virology-proven influenza infection admitted to ICUs between October 2015 and March 2016 were included for analysis...
2018: PloS One
https://www.readbyqxmd.com/read/29314320/patient-agitation-and-its-management-in-adult-critical-care-a-systematic-review-and-narrative-synthesis
#6
REVIEW
Samantha Freeman, Janelle Yorke, Paul Dark
AIM: To critically review the evidence relating to the management of agitation within the Adult Critical Care Unit (ACCU) environment and identify any risks and benefits of current management strategies. BACKGROUND: Admission to an ACCU can be traumatic and potentially life altering for the patient. Patient agitation is common in ACCUs and is associated with the potential for harm. Despite inherent safety risks, there is a paucity of evidence-based guidance underpinning the care of agitation in patients with critical illness...
January 4, 2018: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/29313710/long-term-outcomes-after-protocolized-sedation-vs-usual-care-in-ventilated-pediatric-patients
#7
R Scott Watson, Lisa A Asaro, James H Hertzog, Lauren R Sorce, Alicia G Kachmar, Leslie A Dervan, Derek C Angus, David Wypij, Martha A Q Curley
RATIONALE: Whether a nurse-implemented goal-directed sedation protocol resulting in more awake yet calm intubated children affects post-discharge functional status, health-related quality of life, or risk for post-traumatic stress disorder is unknown. OBJECTIVES: To compare post-discharge outcomes in children with acute respiratory failure cluster randomized to a sedation protocol or usual care. METHODS: A stratified random sample of 1360 patients from 31 centers in the Randomized Evaluation of Sedation Titration for Respiratory Failure trial was assessed by mail, electronically, and/or telephone six months after intensive care unit discharge...
January 9, 2018: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/29310701/severe-thoracic-trauma-still-an-independent-predictor-for-death-in-multiple-injured-patients
#8
Michael Grubmüller, Maximilian Kerschbaum, Eva Diepold, Katharina Angerpointner, Michael Nerlich, Antonio Ernstberger
BACKGROUND: Over the past, the severe thoracic trauma has had decisive influence on the outcome of multiple injured patients. Today, new therapies (e.g. extracorporeal membrane oxygenation (ECMO), protective ventilation methods and new forms of patient positioning) are available and applied regularly. What impact on the patient's outcome does the thoracic trauma have today? METHODS: Prospective data collection of multiple injured patients in a level-I trauma center was performed between 2008 and 2014...
January 8, 2018: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/29308749/-2017-clinical-breakthroughs-in-critical-care-medicine
#9
Wei Huang
New achievements in critical care medicine 2017 may include updating of "Surviving Sepsis Campaign" international guideline. Comparing evaluation of sequential (sepsis-related) organ failure assessment (SOFA) and quick sequential organ failure assessment (qSOFA), combination therapies with steroid, vitamin B1 and vitamin C in patients with sepsis, identification of endophenotype of sepsis, as well phenotype of acute respiratory distress syndrome (ARDS). However, it is also need to mention some of negative trials, such as levosimendan in patients undergoing cardiac surgery, low-dose immunoglobulin G and polymyxin B hemoperfusion for patient with septic shock, and enteral versus parenteral early nutrition in ventilated adults with shock...
January 2018: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/29307960/tropical-fevers-in-indian-intensive-care-units-a-prospective-multicenter-study
#10
Sunit Singhi, Narendra Rungta, Karthi Nallasamy, Ashish Bhalla, J V Peter, Dhruva Chaudhary, Rajesh Mishra, Prakash Shastri, Rajesh Bhagchandani, T D Chugh
Background and Aims: Infections in tropics often present as undifferentiated fevers with organ failures. We conducted this nationwide study to identify the prevalence, profile, resource utilization, and outcome of tropical fevers in Indian Intensive Care Units (ICUs). Materials and Methods: This was a multicenter prospective observational study done in 34 ICUs across India (July 2013-September 2014). Critically ill adults and children with nonlocalizing fever >48 h and onset < 14 days with any of the following: thrombocytopenia/rash, respiratory distress, renal failure, encephalopathy, jaundice, or multiorgan failure were enrolled consecutively...
December 2017: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/29303902/rhabdomyolysis-in-a-tertiary-picu-a-10-year-study
#11
Ben Gelbart, Renata DeMarco, Alexander David Hussey, Siva P Namachivayam, Rosemary McRae, Catherine Quinlan, Trevor Duke
OBJECTIVES: Rhabdomyolysis is a disorder of muscle breakdown. The aim of this study was to describe the epidemiology of rhabdomyolysis in children admitted to a PICU and to assess the relationship between peak creatinine kinase and mortality. DESIGN: Retrospective cohort study in children admitted to the PICU with rhabdomyolysis between January 1, 2005, and December 31, 2014. Demographic, clinical, and outcome data were recorded. Outcomes were analyzed by level of peak creatinine kinase value (0-10,000, 10,001-50,000, > 50,000IU/L)...
January 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29303440/predictive-value-of-positive-high-sensitivity-troponin-t-in-intubated-traumatic-brain-injury-patients
#12
Ayman El-Menyar, Mohammad Asim, Rifat Latifi, Shrikant I Bangdiwala, Hassan Al-Thani
OBJECTIVE The clinical relevance of high-sensitivity troponin T (HsTnT) in trauma patients is not well explored. In this study, the authors aimed to study the predictive value of serum HsTnT in intubated patients who had sustained traumatic brain injury (TBI). METHODS A retrospective analysis was conducted for all intubated TBI patients between 2010 and 2014 at a national level 1 trauma center. Data were analyzed and compared based on the HsTnT status on admission (group 1, negative results; and group 2, positive results)...
January 5, 2018: Journal of Neurosurgery
https://www.readbyqxmd.com/read/29286932/dexamethasone-effect-on-heart-rate-variability-in-preterm-infants-on-mechanical-ventilation
#13
Corrie J Alonzo, Karen D Fairchild
BACKGROUND: Dexamethasone is administered to some preterm infants with chronic lung disease to facilitate weaning from mechanical ventilation. Heart rate characteristics (HRC), including heart rate variability (HRV), may be impacted by glucocorticoids and may predict extubation readiness. A commercially available monitor developed for sepsis detection continuously calculates HRV and an HRC index, which are inversely related. OBJECTIVES: Determine the impact of dexamethasone on HRV and the HRC index, in relation to extubation success...
2017: Journal of Neonatal-perinatal Medicine
https://www.readbyqxmd.com/read/29282094/nasal-high-flow-therapy-in-very-low-birth-weight-infants-with-mild-respiratory-distress-syndrome-a-single-center-experience
#14
Antonio Di Mauro, Manuela Capozza, Sergio Cotugno, Silvio Tafuri, Francesco Paolo Bianchi, Federico Schettini, Raffaella Panza, Nicola Laforgia
BACKGROUND: Pulmonary disorders and respiratory failure represent one of the most common morbidities of preterm newborns admitted to neonatal intensive care units (NICUs). The use of nasal high-flow therapy (nHFT) has been more recently introduced into the NICUs as a non-invasive respiratory (NIV) support. METHODS: We performed a retrospective study to evaluate safety and effectiveness of nHFT as primary support for infants born < 29 weeks of gestation and/or VLBW presenting with mild Respiratory Distress Syndrome (RDS)...
December 28, 2017: Italian Journal of Pediatrics
https://www.readbyqxmd.com/read/29261567/association-between-partial-pressure-of-arterial-carbon-dioxide-and-survival-to-hospital-discharge-among-patients-diagnosed-with-sepsis-in-the-emergency-department
#15
Brian W Roberts, Nicholas M Mohr, Enyo Ablordeppey, Anne M Drewry, Ian T Ferguson, Stephen Trzeciak, Marin H Kollef, Brian M Fuller
OBJECTIVE: The objective of this study was to test the association between the partial pressure of arterial carbon dioxide and survival to hospital discharge among mechanically ventilated patients diagnosed with sepsis in the emergency department. DESIGN: Retrospective cohort study of a single center trial registry. SETTING: Academic medical center. PATIENTS: Mechanically ventilated emergency department patients. INCLUSION CRITERIA: age 18 years and older, diagnosed with sepsis in the emergency department, and mechanical ventilation initiated in the emergency department...
December 19, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/29261564/long-term-return-to-functional-baseline-after-mechanical-ventilation-in-the-icu
#16
Michael E Wilson, Amelia Barwise, Katherine J Heise, Theodore O Loftsgard, Mikhail Dziadzko, Andrea Cheville, Abdul Majzoub, Paul J Novotny, Ognjen Gajic, Michelle Biehl
OBJECTIVE: Predictors of long-term functional impairment in acute respiratory failure of all causes are poorly understood. Our objective was to assess the frequency and predictors of long-term functional impairment or death after invasive mechanical ventilation for acute respiratory failure of all causes. DESIGN: Population-based, observational cohort study. SETTING: Eight adult ICUs of a single center. PATIENTS: All adult patients from Olmsted County, Minnesota, without baseline functional impairment who received mechanical ventilation in ICUs for acute respiratory failure of all causes from 2005 through 2009...
December 19, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/29258377/clinical-features-of-kidney-transplant-recipients-admitted-to-the-intensive-care-unit
#17
Flávio Geraldo Rezende Freitas, Fábio Lombardi, Eduardo Souza Pacheco, Tainá Veras de Sandes-Freitas, Laila Almeida Viana, Hélio Tedesco-Silva Junior, José Osmar Medina-Pestana, Antônio Tonete Bafi, Flavia Ribeiro Machado
INTRODUCTION: There is a paucity of data regarding the complications in kidney transplant patients who may require intensive care unit (ICU) management, despite being the most common solid organ transplant worldwide. OBJECTIVE: To identify the main reasons for ICU admission and to determine the factors associated with hospital mortality in kidney transplant recipients. DESIGN: This single-center retrospective cohort study was conducted between September 2013 and June 2014, including all consecutive kidney transplant patients requiring ICU admission...
January 1, 2017: Progress in Transplantation
https://www.readbyqxmd.com/read/29248382/risk-factors-for-nosocomial-infections-after-cardiac-surgery-in-newborns-with-congenital-heart-disease
#18
Heladia García, Beatriz Cervantes-Luna, Héctor González-Cabello, Guadalupe Miranda-Novales
BACKGROUND: Congenital heart diseases are among the most common congenital malformations. Approximately 50% of the patients with congenital heart disease undergo cardiac surgery. Nosocomial infections (NIs) are the main complications and an important cause of increased morbidity and mortality associated with congenital heart diseases. This study's objective was to identify the risk factors associated with the development of NIs after cardiac surgery in newborns with congenital heart disease...
November 23, 2017: Pediatrics and Neonatology
https://www.readbyqxmd.com/read/29243312/duration-of-anaemia-during-the-first-week-of-life-is-an-independent-risk-factor-for-retinopathy-of-prematurity
#19
Pia Lundgren, Sam E Athikarisamy, Sanjay Patole, Geoffrey C Lam, Lois E Smith, Karen Simmer
AIM: This study evaluated the correlation between retinopathy of prematurity (ROP), anaemia and blood transfusions in extremely preterm infants. METHODS: We included 227 infants born below 28 weeks of gestation at King Edward Memorial Hospital, Perth, Australia, from 2014-2016. Birth characteristics and risk factors for ROP were retrieved and anaemia and severe anaemia were defined as a haemoglobins of <110 g/L and <80 g/L, respectively. Logistic regression was used for the analysis...
December 15, 2017: Acta Paediatrica
https://www.readbyqxmd.com/read/29242415/bronchopulmonary-dysplasia-in-preterm-neonates-in-a-level-iii-neonatal-unit-in-india
#20
Savita Bhunwal, Kanya Mukhopadhyay, Shalmoli Bhattacharya, Pranab Dey, Lakhbir Kaur Dhaliwal
OBJECTIVE: To find out the incidence and associations of bronchopulmonary dysplasia (BPD) in preterm neonates. DESIGN: Prospective, observational. METHODS: All consecutively born neonates <33 weeks gestation requiring oxygen or respiratory support first 3 days of life were enrolled from a level III neonatal unit in Chandigarh, India. Those with malformations were excluded. Placenta was examined for histological chorioamnionitis in preterm rupture of membranes and/or preterm spontaneous onset of labour...
December 14, 2017: Indian Pediatrics
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