MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'Journal of Intensive Care Medicine' source. Thu, 09 Feb 2012 10:59:53 +0100 http://www.medworm.com/index.php?rid=5623895&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Freprint%2F27%2F1%2F68%3Frss%3D1 (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=5623895 Mon, 23 Jan 2012 05:00:00 +0100 5623895 http://www.medworm.com/index.php?rid=5623894&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Freprint%2F27%2F1%2F66%3Frss%3D1 (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=5623894 Mon, 23 Jan 2012 05:00:00 +0100 5623894 http://www.medworm.com/index.php?rid=5623893&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Freprint%2F27%2F1%2F65%3Frss%3D1 (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=5623893 Mon, 23 Jan 2012 05:00:00 +0100 5623893 http://www.medworm.com/index.php?rid=5623892&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F27%2F1%2F58%3Frss%3D1 We present 3 patients with HLH who were admitted to our adult medical intensive care unit (MICU) over a 2-year period with fatal outcomes and emphasize the diagnostic importance of markedly elevated serum ferritin levels and the need for tissue biopsy in making an accurate diagnosis in a timely manner. (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=5623892 Mon, 23 Jan 2012 05:00:00 +0100 5623892 http://www.medworm.com/index.php?rid=5623891&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F27%2F1%2F55%3Frss%3D1 Conclusion: Community-acquired MRSA pneumonia is a growing health threat that typically presents in young adults after, or in conjunction with, a flu-like illness. It is characterized by a rapidly progressive deteriorating clinical course. (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=5623891 Mon, 23 Jan 2012 05:00:00 +0100 5623891 http://www.medworm.com/index.php?rid=5623890&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F27%2F1%2F45%3Frss%3D1 Conclusions: Even with an increased focus on improving EOLC, significant differences continue to exist between the perspectives of nurses and physicians, as well as physicians among themselves and nurses among themselves. These differences may represent significant barriers toward providing comprehensive, consistent, and coordinated EOLC in the ICU. (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=5623890 Mon, 23 Jan 2012 05:00:00 +0100 5623890 http://www.medworm.com/index.php?rid=5623889&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F27%2F1%2F37%3Frss%3D1 Conclusions. The findings favor the concept of dynamic adrenal function rather than poor reproducibility of the ACTH test, so that development of CIRCI, particularly in complicated septic shock and indicated by a fall in cortisol (to <100 nmol/L) upon ACTH, correlates to a poor prognosis, independently of baseline cortisol, cortisol binding in blood, and disease severity. (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=5623889 Mon, 23 Jan 2012 05:00:00 +0100 5623889 http://www.medworm.com/index.php?rid=5623888&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F27%2F1%2F32%3Frss%3D1 Conclusion: Early outcome seems independent of weight, prematurity, cardiopulmonary bypass, and type of first intervention. Importantly, there was no statistical difference in mortality between the 2 groups, regardless of how they were treated. Further long-term follow-up is needed in this patient population. (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=5623888 Mon, 23 Jan 2012 05:00:00 +0100 5623888 http://www.medworm.com/index.php?rid=5623887&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F27%2F1%2F25%3Frss%3D1 Conclusion: A high percentage of patients with H1N1 presented with underlying comorbid conditions including asthma and pregnancy. Traditional markers of pneumonia severity including CURB-65 score, Pneumonia Severity Index (PSI), serum lactate, and AG did not correlate with ICU admission in patients with H1N1. Strong ion gap effectively identified significant acid–base disturbances not identified by lactate or AG, however the trend of greater ICU admission rates among patients with elevated SIG did not reach statistical significance. Further study is needed to identify clinical tools to aid in risk-stratifying H1N1 patients. (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=5623887 Mon, 23 Jan 2012 05:00:00 +0100 5623887 http://www.medworm.com/index.php?rid=5623886&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F27%2F1%2F11%3Frss%3D1 Posterior reversible encephalopathy syndrome (PRES) is characterized by headache, altered mental status, visual disturbances, and seizures. Radiological features typically include edema of the posterior cerebral regions, especially of the parietooccipital lobes. Atypical imaging features, such as involvement of anterior cerebral regions, deep white matter, and the brain stem are also frequently seen. Vasoconstriction is common in vascular imaging. Different conditions have been associated with PRES, but toxemia of pregnancy, solid organ or bone marrow transplantation, immunosuppressive treatment, cancer chemotherapy, autoimmune diseases, and hypertension are most commonly described. The pathophysiology of PRES is unclear and different hypotheses are being discussed. Posterior reversible en... Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=5623886 Mon, 23 Jan 2012 05:00:00 +0100 5623886 http://www.medworm.com/index.php?rid=5623885&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F27%2F1%2F3%3Frss%3D1 Recent events and regulatory mandates have underlined the importance of medical planning and preparedness for catastrophic events. The purpose of this review is to provide a brief summary of current commonly identified threats, an overview of mass critical care management, and a discussion of resource allocation to provide the intensive care unit (ICU) director with a practical guide to help prepare and coordinate the activities of the multidisciplinary critical care team in the event of a disaster. (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=5623885 Mon, 23 Jan 2012 05:00:00 +0100 5623885 http://www.medworm.com/index.php?rid=5436326&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F6%2F397%3Frss%3D1 Conclusion: A wide variety of drugs are used for analgesia and sedation in European burn centers. This would appear to be due to lack of guidelines or scientific evidence. The implementation of regular assessment of sedation, analgesia, and delirium must be improved. The widespread use of neuromuscular blocking agents should be restricted or even abandoned. Two thirds of the units identify a need for change in their concepts. Valid scientific data are needed to develop guidelines for sedation and analgesia of burn patients. (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=5436326 Mon, 21 Nov 2011 05:00:00 +0100 5436326 http://www.medworm.com/index.php?rid=5436325&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F6%2F392%3Frss%3D1 Conclusions. Using a 15-cm insertion depth via the internal jugular or subclavian vein results in safe catheter tip location in the majority of procedures consistent with FDA and manufacturer guidelines. (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=5436325 Mon, 21 Nov 2011 05:00:00 +0100 5436325 http://www.medworm.com/index.php?rid=5436324&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F6%2F385%3Frss%3D1 Conclusions: Our results suggested no survival benefit but a trend toward higher cure rate with linezolid therapy. The optimal treatment of MRSA VAP requires further study through randomized, controlled trials. (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=5436324 Mon, 21 Nov 2011 05:00:00 +0100 5436324 http://www.medworm.com/index.php?rid=5436323&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F6%2F368%3Frss%3D1 This article details how these questions developed and provides a description of the possible answers. In the first section, we review a selection of seminal articles by noted authors in the fields of ethics, medicine, and law. The second section provides a detailed account of the development of the Baby Doe Regulations and the impact they had on neonatal ethics, with particular attention to the emergence of the Best Interest Standard as a guideline for decision making. In the last section, we review the landmark position statements by the American Academy of Pediatric (AAP), and the focus on evidence-based decision making. We conclude that forgoing life-saving treatment is ethically justified. However, this requires a rigorous evidence-based process and is limited by the Best Interest Sta... Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=5436323 Mon, 21 Nov 2011 05:00:00 +0100 5436323 http://www.medworm.com/index.php?rid=5436322&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F6%2F347%3Frss%3D1 In a 5-week span during the 1918 influenza A pandemic, more than 2000 patients were admitted to Cook County Hospital in Chicago, with a diagnosis of either influenza or pneumonia; 642 patients, approximately 31% of those admitted, died, with deaths occurring predominantly in patients of age 25 to 30 years. 1 This review summarizes basic information on the biology, epidemiology, control, treatment and prevention of influenza overall, and then addresses the potential impact of pandemic influenza in an intensive care unit setting. Issues that require consideration include workforce staffing and safety, resource management, alternate sites of care surge of patients, altered standards of care, and crisis communication. (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=5436322 Mon, 21 Nov 2011 05:00:00 +0100 5436322 http://www.medworm.com/index.php?rid=5202452&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Freprint%2F26%2F5%2F343%3Frss%3D1 (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=5202452 Wed, 07 Sep 2011 04:00:00 +0100 5202452 http://www.medworm.com/index.php?rid=5202451&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Freprint%2F26%2F5%2F341%3Frss%3D1 (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=5202451 Wed, 07 Sep 2011 04:00:00 +0100 5202451 http://www.medworm.com/index.php?rid=5202450&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Freprint%2F26%2F5%2F335%3Frss%3D1 (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=5202450 Wed, 07 Sep 2011 04:00:00 +0100 5202450 http://www.medworm.com/index.php?rid=5202449&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F5%2F330%3Frss%3D1 A 1.4-kilogram, male infant was born at 27 weeks gestation at an outside hospital. After birth, the patient’s trachea was intubated and surfactant administered. Initial echocardiogram showed a patent ductus arteriosus (PDA) and a ventricular septal defect (VSD), with a possible aberrant vessel arising from the carotid artery. The patient was transferred to our hospital for further management. Repeat echocardiogram showed a right aortic arch with the left common carotid/innominate artery arising from the pulmonary artery. The infant was subsequently brought to the operating room where following sternotomy, the aberrant left innominate artery was reimplanted into the aorta. The origin of the left carotid artery or innominate artery from the pulmonary artery is an extremely rare form of... Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=5202449 Wed, 07 Sep 2011 04:00:00 +0100 5202449 http://www.medworm.com/index.php?rid=5202448&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F5%2F326%3Frss%3D1 Conclusion: Massive aspiration of fluid occurs along the tracheal tube cuff during suction with the closed tracheal suction system. (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=5202448 Wed, 07 Sep 2011 04:00:00 +0100 5202448 http://www.medworm.com/index.php?rid=5202447&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F5%2F318%3Frss%3D1 Conclusions: Unlike seasonal influenza, our patients were not in the extremes of age. Most were obese and presented with severe respiratory distress and hypoxia in the summer months. A negative RIDT did not exclude pandemic H1N1 2009. Using a higher dose of oseltamivir and nonconventional modes of ventilation may have improved the outcome in our subset of patients. Hence, patients with a high clinical suspicion of severe influenza infection should be treated early and aggressively, even before confirmatory results are available. (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=5202447 Wed, 07 Sep 2011 04:00:00 +0100 5202447 http://www.medworm.com/index.php?rid=5202446&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F5%2F314%3Frss%3D1 Heparin prophylaxis (HP) is commonly used for prevention of central venous catheter (CVC)-related complications among pediatric intensivists, yet efficacy of this therapy is unknown. We conducted a survey of pediatric intensivists and their experiences with HP. A total of 96 responses were received. Almost half of the respondents regularly used HP in patients with CVCs, yet most were unsure of its benefit. The majority of respondents claimed to experience no adverse effects; the complications that were reported to occur were related to bleeding or suspected heparin-induced thrombocytopenia (HIT). Overall, participants felt CVC-associated HP was safe in pediatric critical illness, while acknowledging the paucity of compelling data. (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=5202446 Wed, 07 Sep 2011 04:00:00 +0100 5202446 http://www.medworm.com/index.php?rid=5202445&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F5%2F304%3Frss%3D1 Conclusions: Initiating the sepsis RB for patients with severe sepsis and/or septic shock decreased mortality. A CQI initiative that monitored the implementation in real-time allowed for improvement in compliance and efficacy of the bundle on outcomes. Multiple studies have shown that compliance to the RB within 6 hours lowers hospital mortality. This study uniquely shows that when bundle completion is extended to 18 hours, the mortality reduction remains significant. (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=5202445 Wed, 07 Sep 2011 04:00:00 +0100 5202445 http://www.medworm.com/index.php?rid=5202444&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F5%2F295%3Frss%3D1 Proper critical care training and management rests on 3 pillars—evidence-based patient care, proficient procedural skills, and compassionate end-of-life (EOL) management. The purpose of this manuscript is to provide a practical guide to EOL management for all bedside practitioners. The manuscript outlines not all but some fundamentally important ethical concepts and provides helpful rules and steps on end-of-life management based on my own personal experience and practice. Moreover, nowhere in the rigorous training of critical care or hospitalist physicians do we teach the procedure for removal of life-sustaining measures. Like any other procedure in medicine, it requires preparation, implementation and conclusion, as well as supervision and repetition to become proficient. Therefore... Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=5202444 Wed, 07 Sep 2011 04:00:00 +0100 5202444 http://www.medworm.com/index.php?rid=5202443&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F5%2F275%3Frss%3D1 Pulmonary embolus (PE) is estimated to cause 200 000 to 300 000 deaths annually. Many deaths occur in hemodynamically unstable patients and the estimated mortality for inpatients with hemodynamic instability is between 15% and 25%. The diagnosis of PE in the critically ill is often challenging because the presentation is nonspecific. Computed tomographic pulmonary angiography appears to be the most useful study for diagnosis of PE in the critically ill. For patients with renal insufficiency and contrast allergy, the ventilation perfusion scan provides an alternative. For patients too unstable to travel, echocardiography (especially transesophageal echocardiography) is another option. A positive result on lower extremity Doppler ultrasound can also aid in the decision to treat. The choice o... Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=5202443 Wed, 07 Sep 2011 04:00:00 +0100 5202443 http://www.medworm.com/index.php?rid=5034674&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F4%2F267%3Frss%3D1 Adenovirus infections occur primarily in infants and children less than 5 years of age, accounting for 2% to 5% of respiratory illnesses in the pediatric population and 4% to 10% of childhood pneumonias. Although the majority of children with adenovirus disease develop mild upper respiratory tract disease, more severe disease may occur with involvement of the lower respiratory tract characterized by pneumonitis and/or small airways disease. The authors present a case series of 3 high-risk children with severe lower respiratory tract adenoviral infections. These cases demonstrate the potential for the development of severe respiratory involvement from adenovirus in infants and children with comorbid conditions and illustrate that there may be a rapid progression of the disease as well as th... Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=5034674 Wed, 13 Jul 2011 23:00:00 +0100 5034674 http://www.medworm.com/index.php?rid=5034673&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F4%2F261%3Frss%3D1 Managing the airway in the intensive care unit (ICU) is complicated by a wide array of physiologic factors. Difficult airway may be a consequence of patient’s anatomy or airway edema developed during the ICU stay and mechanical ventilation. The incidence of failed airways and of cardiac arrest related to airway instrumentation in the ICU is much higher than that of elective intubations performed in the operating room. In this article, we will provide a framework for identifying a difficult airway, criteria for safe extubation, as well as review the devices that are available for airway management in the ICU. Proficiency in identifying a potentially difficult airway and thorough familiarity with strategies and techniques of securing the airway are necessary for safe practice of critic... Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=5034673 Wed, 13 Jul 2011 23:00:00 +0100 5034673 http://www.medworm.com/index.php?rid=5034672&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F4%2F255%3Frss%3D1 We sought to determine which of 3 methods used to evaluate cardiac index (CI) is the most accurate using focused bedside echocardiography (ECHO). We hypothesized that the fractional shortening (FS) method would provide a more accurate estimate of CI than the left ventricular outflow tract/velocity-time integral (LVOT/VTI) or Simpson’s methods. This was a prospective observational cohort study conducted in the surgical ICU of an urban level 1 trauma center utilizing all patients with a pulmonary artery catheter (PAC) in place. Three surgical intensive care unit (SICU) faculty and 3 fellows underwent focused cardiac ultrasound training. Focused ECHO exams—bedside echocardiographic assessment in trauma/critical care (BEAT)— were performed using the Sonosite portable ultrasou... Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=5034672 Wed, 13 Jul 2011 23:00:00 +0100 5034672 http://www.medworm.com/index.php?rid=5034671&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F4%2F250%3Frss%3D1 Conclusion: This study has shown that serum bicarbonate <20 mmol/L is the most important risk factor of mortality in our patients with TEN and it may be used as a marker to predict hospital mortality. (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=5034671 Wed, 13 Jul 2011 23:00:00 +0100 5034671 http://www.medworm.com/index.php?rid=5034670&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F4%2F237%3Frss%3D1 Research in the intensive care unit (ICU) raises a number of scientific and ethical challenges. Potential participants in critical care studies are likely to be considered particularly vulnerable—they may lack sufficient capacity to make informed decisions about trial participation, their health care proxies may lack legal authority to enroll them in research trials or may not know their true intent, and the life-threatening nature of the illness may make them or their surrogates more susceptible to therapeutic misconception. Because of this, critical care investigators must exercise extreme caution when designing and conducting studies in the ICU. In this article, we review the key literature addressing the various scientific and ethical issues raised by critical care research, incl... Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=5034670 Wed, 13 Jul 2011 23:00:00 +0100 5034670 http://www.medworm.com/index.php?rid=5034669&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F4%2F223%3Frss%3D1 Care of the severely injured patient with burn requires correct diagnosis, appropriately tailored resuscitation, and definitive surgical management to reduce morbidity and mortality. Currently, mortality rates related to severe burn injuries continue to steadily decline due to the standardization of a multidisciplinary approach instituted at tertiary health care centers. Prompt and accurate diagnoses of burn wounds utilizing Lund-Browder diagrams allow for appropriate operative and nonoperative management. Coupled with diagnostic improvements, advances in resuscitation strategies involving rates, volumes, and fluid types have yielded demonstrable benefits related to all aspects of burn care. More recently, identification of comorbid conditions such as inhalation injury and malnutrition hav... Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=5034669 Wed, 13 Jul 2011 23:00:00 +0100 5034669 http://www.medworm.com/index.php?rid=5034668&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F4%2F209%3Frss%3D1 Recipients of solid organ or hematopoietic cell transplants are at risk of life-threatening neurological disorders including encephalopathy, seizures, infections and tumors of the central nervous system, stroke, central pontine myelinolysis, and neuromuscular disorders—often requiring admission to, or occurring in, the intensive care unit (ICU). Many of these complications are linked directly or indirectly to immunosuppressive therapy. However, neurological disorders may also result from graft versus host disease, or be an expression of the underlying disease which prompted transplantation, as well as injury induced during radiation, chemotherapy, surgery, and ICU stay. In rare cases, neuroinfectious pathogens may be transmitted with the transplanted tissue or organ. Diagnosis may be... Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=5034668 Wed, 13 Jul 2011 23:00:00 +0100 5034668 http://www.medworm.com/index.php?rid=4827034&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Freprint%2F26%2F3%2F201%3Frss%3D1 (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=4827034 Thu, 12 May 2011 23:00:00 +0100 4827034 http://www.medworm.com/index.php?rid=4827033&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Freprint%2F26%2F3%2F196%3Frss%3D1 (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=4827033 Thu, 12 May 2011 23:00:00 +0100 4827033 http://www.medworm.com/index.php?rid=4827032&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F3%2F183%3Frss%3D1 The natriuretic peptide system plays an active role in the regulation of fluid balance and systemic vascular resistance. Peptides of the natriuretic system produced through recombinant DNA technology are now available for clinical use including both atrial natriuretic peptide (ANP) and brain-type natriuretic peptide (BNP). Assays of BNP are available and may be used for both diagnostic and prognostic purposes in various clinical scenarios. The basic physiology of the natriuretic peptide system is presented, applications of BNP monitoring as a diagnostic tool are reviewed, and reports regarding the use of recombinant BNP in the pediatric population are discussed. (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=4827032 Thu, 12 May 2011 23:00:00 +0100 4827032 http://www.medworm.com/index.php?rid=4827031&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F3%2F172%3Frss%3D1 Realizing the vast medical benefits of validated protocols, recommendations and practice guidelines requires acceptance and implementation by frontline care providers. Knowledge translation is the science of accelerating the transfer of knowledge to practice by understanding and creatively addressing the barriers that prevent adoption of new professional standards. In an attempt to improve patient care and reduce mortality, the Surviving Sepsis Campaign and The Institute for Healthcare Improvement created the resuscitation and management bundles for patients with severe sepsis and septic shock. These bundles have been accepted as best practice by many clinicians since multiple clinical trials have produced similar positive results when they were implemented. However, transferring these res... Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=4827031 Thu, 12 May 2011 23:00:00 +0100 4827031 http://www.medworm.com/index.php?rid=4827030&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F3%2F165%3Frss%3D1 The implementation of health information technology (HIT) is accelerating, driven in part by a growing interest in computerized physician order entry (CPOE) as a tool for improving the quality and safety of patient care. Computerized physician order entry could have a substantial impact on patients in intensive care, where the potential for medical error is high, and the clinical workflow is complex. In 2009, only 17% of hospitals had functional CPOE systems in place. In intensive care unit (ICU) settings, CPOE has been shown to reduce the occurrence of some medication errors, but evidence of a beneficial effect on clinical outcomes remains limited. In some cases, new error types have arisen with the use of CPOE. Intensive care unit workflow and staff relationships have been affected by CP... Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=4827030 Thu, 12 May 2011 23:00:00 +0100 4827030 http://www.medworm.com/index.php?rid=4827029&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F3%2F151%3Frss%3D1 With the introduction of highly active antiretroviral therapy (HAART), HIV has become a chronic disease. As HIV-infected patients are aging, they are at increased risk for comorbid diseases. These non-AIDS related diseases account for a growing proportion of intensive care unit (ICU) admissions in HIV-infected patients in recent studies. HIV-infected patients still present to the ICU with HIV-related conditions such as Pneumocystis jirovecii pneumonia (PCP), but these conditions are becoming less common. Respiratory failure remains the most common indication for ICU admission. Immune reconstitution inflammatory response syndrome and toxicities related to HAART may also result in ICU admission. While ICU survival has improved since the earliest era of the HIV epidemic, hospital mortality fo... Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=4827029 Thu, 12 May 2011 23:00:00 +0100 4827029 http://www.medworm.com/index.php?rid=4827028&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F3%2F135%3Frss%3D1 This article will review the biologic mechanisms that may help us understand why and how hyperglycemia and insulin are relevant in critical illness. We will then explore insights gleaned from available clinical trials. Finally, we will discuss specific areas of controversy that relate to the implementation of glycemic control in the intensive care unit, such as the ideal glucose target and the importance of hypoglycemia. (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=4827028 Thu, 12 May 2011 23:00:00 +0100 4827028 http://www.medworm.com/index.php?rid=4675381&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F2%2F125%3Frss%3D1 Conclusions: Our data show that serum cytokine disturbance patterns have prognostic significance in patients with septic shock admitted to the ICU. The pattern, defined by an early response to continuously elevated anti-inflammatory cytokine serum levels, is associated with an enhanced risk of a fatal outcome for patients. (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=4675381 Sat, 02 Apr 2011 23:00:00 +0100 4675381 http://www.medworm.com/index.php?rid=4675380&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F2%2F116%3Frss%3D1 Conclusions: ECHO assessment of the IVC variation during mechanical ventilation may prove to be a useful technique to predict FRes and guide fluid resuscitation in the ICU. The SVV obtained with the Vigileo monitor failed to predict FRes likely due to lack of calibration and the use of a complex algorithm that may be unreliable in patients with sepsis. (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=4675380 Sat, 02 Apr 2011 23:00:00 +0100 4675380 http://www.medworm.com/index.php?rid=4675379&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F2%2F111%3Frss%3D1 Conclusion: Enoxaparin 30 mg twice-daily may be more effective than enoxaparin 40 mg once-daily for prevention of VTE in high-risk trauma patients; however, statistical significance was not achieved. There were no statistically significant differences observed in clinically significant bleeding. Further study is needed to clarify which dosing regimen of enoxaparin is superior with regard to safety and effectiveness. (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=4675379 Sat, 02 Apr 2011 23:00:00 +0100 4675379 http://www.medworm.com/index.php?rid=4675378&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F2%2F105%3Frss%3D1 Small intestinal function in critically ill patients should ideally be assessed in order to determine the preferred feeding route, timing, and composition of enteral nutrition. Additionally, evaluation of small bowel function may lead to new insights aimed to maintain enterocyte integrity. Critically ill patients are likely to have impaired enterocyte function mainly as a consequence of diminished splanchnic blood flow associated with mucosal hyperpermeability and bacterial translocation, a pathological state believed to be pivotal in the development of sepsis and multiple organ dysfunction syndrome (MODS). However, feasible and validated clinical tools to reliably assess enterocyte function are lacking. This explorative review discusses the promising role of citrulline, a nonprotein amino... Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=4675378 Sat, 02 Apr 2011 23:00:00 +0100 4675378 http://www.medworm.com/index.php?rid=4675377&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F2%2F88%3Frss%3D1 Pulmonary vasculitis can occur in apparent isolation, as part of a primary systemic vasculitis, or with an underlying systemic inflammatory autoimmune disorder. The presentation of pulmonary vasculitis in the intensive care unit (ICU) can be fulminant and will often overlap with more common disorders that affect the critically ill. Although diffuse alveolar hemorrhage (DAH) is the clinical feature that often initiates the concern for an underlying vasculitis, hemoptysis may not be apparent or its presentation can be mistaken for an alternative disease process. As a result, the diagnosis of pulmonary vasculitis in the ICU may be delayed or be completely unrecognized. A high level of suspicion is essential to obtain a timely diagnosis and for effective therapies to be implemented. There have... Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=4675377 Sat, 02 Apr 2011 23:00:00 +0100 4675377 http://www.medworm.com/index.php?rid=4675376&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F2%2F73%3Frss%3D1 A variety of cytokines play a role in the inflammatory response. Interleukin-6 (IL-6)-type cytokines are released in response to tissue injury or an inflammatory stimulus, and act locally and systemically to generate a variety of physiologic responses. Interleukin-6 concentrations are elevated after surgery, trauma, and critical illness. The magnitude of IL-6 elevation correlates with the extent of tissue trauma/injury severity. Furthermore, there is an association between IL-6 elevation and adverse outcome. Interleukin-6 levels can also be used to stratify patients for therapeutic intervention. (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=4675376 Sat, 02 Apr 2011 23:00:00 +0100 4675376 http://www.medworm.com/index.php?rid=4675375&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F2%2F59%3Frss%3D1 This article reviews the reported cases of PRIS and describes the current understanding of the underlying pathophysiology and treatment options. (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=4675375 Sat, 02 Apr 2011 23:00:00 +0100 4675375 http://www.medworm.com/index.php?rid=4393098&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F1%2F50%3Frss%3D1 Conclusions: EEI may be performed by pulmonary/critical medicine (PCCM) fellows with safety comparable to that described in other studies on EEI. Important parts of the program included the use of formal iterative QI approach, the use of intensive SBT with CPS, basic CRM, a comprehensive checklist, and a combined team approach. A key benefit of the program was to make the process of EEI fully transparent for ongoing quality and safety improvement. (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=4393098 Sun, 23 Jan 2011 00:00:00 +0100 4393098 http://www.medworm.com/index.php?rid=4393097&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F1%2F41%3Frss%3D1 Conclusions: In all, 80% of the patients with early ALI responded to the SRM with decremental PEEP titration. Desaturation during the SRM did not indicate a failed response 1 hour later. (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=4393097 Sun, 23 Jan 2011 00:00:00 +0100 4393097 http://www.medworm.com/index.php?rid=4393096&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F1%2F34%3Frss%3D1 Conclusions: Despite early diagnosis and appropriate antibiotic therapy, conventionally treated CAP with PSI = 5, CURB-65 ≥3, or APACHE II ≥25 has an unacceptably high mortality. In this study, PSI, CURB-65, and APACHE II scoring systems perform similarly in predicting the 28-day and in-hospital mortality; however, differences in the categorization of severe CAP were observed and there was a significant mortality in patients with a CURB-65 <3 and PSI <5. (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=4393096 Sun, 23 Jan 2011 00:00:00 +0100 4393096 http://www.medworm.com/index.php?rid=4393095&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F1%2F27%3Frss%3D1 This paper reports the result of the MEDAN project that analyzes a multicenter septic shock patient data collection. The mortality prognosis based on 4 scores that are often used is compared with the prognosis of a trained neural network. We built an alarm system using the network classification results. Method. We analyzed the data of 382 patients with abdominal septic shock who were admitted to the intensive care unit (ICU) from 1998 to 2002. The analysis includes the calculation of daily sepsis-related organ failure assessment (SOFA), Acute Physiological and Chronic Health Evaluation (APACHE) II, simplified acute physiology score (SAPS) II, multiple-organ dysfunction score (MODS) scores for each patient and the training and testing of an appropriate neural network. Results. For our pati... Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=4393095 Sun, 23 Jan 2011 00:00:00 +0100 4393095 http://www.medworm.com/index.php?rid=4393094&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F1%2F13%3Frss%3D1 Extracorporeal membrane oxygenation (ECMO) comprises a commonly used method of extracorporeal life support. It has proven efficacy and is an accepted modality of care for isolated respiratory or cardiopulmonary failure in neonatal and pediatric populations. In adults, there are conflicting studies regarding its benefit, but it is possible that ECMO may be beneficial in certain adult populations beyond postcardiotomy heart failure. As such, all intensivists should be familiar with the evidence-base and principles of ECMO in adult population. The purpose of this article is to review the evidence and to describe the fundamental steps in initiating, adjusting, troubleshooting, and terminating ECMO so as to familiarize the intensivist with this modality. (Source: Journal of Intensive Care Medic... Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=4393094 Sun, 23 Jan 2011 00:00:00 +0100 4393094 http://www.medworm.com/index.php?rid=4393093&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F1%2F3%3Frss%3D1 A variety of cytokines play a role in the response to an inflammatory stimulus. The interleukin-6 (IL-6)-type cytokines are released in response to tissue injury or an inflammatory stimulus. They act locally and systemically to generate a variety of physiologic responses, principal among them is the acute phase response. The IL-6 type cytokines demonstrate pleiotropy and redundancy of actions. This is made possible by the distinctive characteristics of the IL-6 receptor complex, which contains an ubiquitous subunit that is shared by most IL-6-type cytokines, as well as a cytokine-specific subunit. (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=4393093 Sun, 23 Jan 2011 00:00:00 +0100 4393093 http://www.medworm.com/index.php?rid=4157717&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Freprint%2F25%2F6%2F358%3Frss%3D1 (No abstract is available for this citation) (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=4157717 Thu, 11 Nov 2010 00:00:00 +0100 4157717 http://www.medworm.com/index.php?rid=4157716&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F6%2F353%3Frss%3D1 Conclusion: Band count may provide useful information in patients whose diagnosis of infection is uncertain. An elevated band count leads to a moderate increase in the likelihood of infection. A negative test, however, leads to only a small change in the posttest probability of infection. (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=4157716 Thu, 11 Nov 2010 00:00:00 +0100 4157716 http://www.medworm.com/index.php?rid=4157715&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F6%2F349%3Frss%3D1 Clevidipine is a third-generation calcium channel antagonist of the dihydropyridine group. Like nicardipine, its primary physiologic effect is vasodilation, primarily of the arterial system with limited effects on capacitance vessels. Unlike other direct-acting vasodilators, it has an ultrashort half-life due to its metabolism by nonspecific blood and tissue esterases. To date, the majority of clinical experience with clevidipine has been in the adult cardiac surgery population, with no reports regarding its use in the pediatric population. We retrospectively reviewed our preliminary experience with the use of this novel agent in a cohort of 10 pediatric-aged patients ranging in age from 9 to 18 years. The indications for the use of clevidipine included control of perioperative hypertensio... Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=4157715 Thu, 11 Nov 2010 00:00:00 +0100 4157715 http://www.medworm.com/index.php?rid=4157714&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F6%2F343%3Frss%3D1 Conclusions: Our results demonstrated that CR-Acinetobacter VAP can be effectively treated with second-line agents. However, colistin-related nephrotoxicity was much higher than recently reported and decreased susceptibility to tigecycline emerged on therapy demonstrating the limitations of alternative regimens. (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=4157714 Thu, 11 Nov 2010 00:00:00 +0100 4157714 http://www.medworm.com/index.php?rid=4157713&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F6%2F327%3Frss%3D1 Antibacterial resistance is increasing throughout the world, while the development of new agents is slowly progressing. In addition, the increasing prevalence of fluoroquinolone resistance may force many practitioners to choose an aminoglycoside agent in gram-negative regimens. Aminoglycosides are bactericidal agents with potent activity against gram-negative infections and activity against gram-positive infections when added to a cell wall active antimicrobial-based regimen. These agents may be dosed multiple times a day or consolidated as high-dose, extended-interval dosing to maximize pharmacokinetic and pharmacodynamic properties to achieve possible improved efficacy with reduced toxicity. Clinical application includes the treatment of bacteremia, endocarditis, health-care and nosocomi... Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=4157713 Thu, 11 Nov 2010 00:00:00 +0100 4157713 http://www.medworm.com/index.php?rid=4157712&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F6%2F307%3Frss%3D1 Viral infections have always been considered pediatric diseases. However, viral pneumonia has become an important cause of morbidity and mortality in immuncompromised adults. Improved diagnostic techniques, such as the introduction of highly sensitive nucleic acid amplification tests, have not only allowed us to discover new viruses but also to determine the etiology of viral pneumonia in immunocompromised adult hosts. Unfortunately, only a few antiviral agents are available. Thus, early diagnosis and treatment are crucial to patient outcome. In this article, we review the most common viruses that have been implicated as etiologic agents of viral pneumonia in immunocompromised adults. We discuss the epidemiologic characteristics and clinical presentation of these viral infections and the m... Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=4157712 Thu, 11 Nov 2010 00:00:00 +0100 4157712 http://www.medworm.com/index.php?rid=3919265&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Freprint%2F25%2F5%2F301%3Frss%3D1 (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=3919265 Wed, 01 Sep 2010 08:01:06 +0100 3919265 http://www.medworm.com/index.php?rid=3919264&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F5%2F286%3Frss%3D1 We present a review of the evidence behind use of the serum lactate level in this setting. (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=3919264 Wed, 01 Sep 2010 08:01:06 +0100 3919264 http://www.medworm.com/index.php?rid=3919263&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F5%2F281%3Frss%3D1 We report 3 cases of severe pleuropulmonary complications after routine bedside placement of a narrow-bore enteral feeding tubes and a review of the literature. These episodes have not only prompted our adoption of a new policy specifying the routine use of ultrasound to guide feeding tube placement in obtunded or mechanically ventilated patients but also offer recommendations post-removal of misplaced feeding tubes. (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=3919263 Wed, 01 Sep 2010 08:01:06 +0100 3919263 http://www.medworm.com/index.php?rid=3919262&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F5%2F271%3Frss%3D1 The objective of this study is to develop a physicochemical model of the projected change in standard base excess (SBE) consequent to the infused volume of crystalloid solutions in common use. A clinical simulation of modeled acid-base and fluid compartment parameters was conducted in a 70-kg test participant at standard physiologic state: pH = 7.40, partial pressure of carbon dioxide (PCO2) = 40 mm Hg, Henderson—Hasselbalch actual bicarbonate ([HCO3] HH) = 24.5 mEq/L, strong ion difference (SID) = 38.9 mEq/L, albumin = 4.40 g/dL, inorganic phosphate = 1.16 mmol/L, citrate total = 0.135 mmol/L, and SBE = 0.1 mEq/L. Simulations of multiple, sequential crystalloid infusions up to 10 L were conducted of normal saline (SID = 0), lactated Ringer’s (SID = 28), plasmalyte 148 (SID = 5... Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=3919262 Wed, 01 Sep 2010 08:01:06 +0100 3919262 http://www.medworm.com/index.php?rid=3919261&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F5%2F259%3Frss%3D1 Nosocomial pneumonia is a major cause of morbidity and mortality for hospitalized patients. Antimicrobial resistance is increasing, creating a strain between ensuring the provision of adequate empiric therapy and slowing the development of antimicrobial resistance. Excessive antimicrobial therapy places patients are at greater risk of drug interactions, adverse events, and superinfections. Ways to maximize adequate empiric therapy include (1) categorizing each patient’s risk of being infected with a multidrug-resistant pathogen and knowledge of local susceptibility patterns, (2) de-escalating antimicrobial therapy to decrease the rates of superinfections such as Clostridium difficile, and (3) limiting the duration of therapy to decrease the likelihood of adverse events, drug interact... Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=3919261 Wed, 01 Sep 2010 08:01:06 +0100 3919261 http://www.medworm.com/index.php?rid=3919260&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F5%2F247%3Frss%3D1 Scleroderma or systemic sclerosis (SSc) is a connective tissue disease (CTD) associated with fibrosing and vascular complications involving multiple organs. The care of these patients in the critical care setting is frequently challenging due to multiple complications and refractory organ involvement. However, awareness of specific organ involvement associated with scleroderma can allow many complications to be anticipated and effectively treated. Cardiac involvement can lead to arrthymias and heart failure, whereas pulmonary involvement can be associated with pulmonary arterial hypertension, fibrosis, or both. Renal vascular disease and scleroderma renal crisis (SRC), once a uniformly fatal complication, is particularly important to recognize early, as it can be treated successfully. Gast... Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=3919260 Wed, 01 Sep 2010 08:01:06 +0100 3919260 http://www.medworm.com/index.php?rid=3789880&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Freprint%2F25%2F4%2F244%3Frss%3D1 (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=3789880 Tue, 27 Jul 2010 06:24:23 +0100 3789880 http://www.medworm.com/index.php?rid=3789879&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Freprint%2F25%2F4%2F243%3Frss%3D1 (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=3789879 Tue, 27 Jul 2010 06:24:23 +0100 3789879 http://www.medworm.com/index.php?rid=3789878&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Freprint%2F25%2F4%2F240%3Frss%3D1 (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=3789878 Tue, 27 Jul 2010 06:24:23 +0100 3789878 http://www.medworm.com/index.php?rid=3789877&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F4%2F233%3Frss%3D1 Conclusions: For critically ill veterans admitted to an MICU requiring MV, a high-intensity ICU structure is associated with more favorable mechanical ventilatory outcomes and lower mortality. (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=3789877 Tue, 27 Jul 2010 06:24:23 +0100 3789877 http://www.medworm.com/index.php?rid=3789876&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F4%2F227%3Frss%3D1 Conclusions: In our mixed medical—surgical ICU the diagnostic and therapeutic efficacy of routinely obtained admission CXRs is low, though not completely negligible. Highest efficacy of CXRs was found in nonsurgical patients. Prospective studies are needed to determine whether abolishing this diagnostic test is a safe strategy. (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=3789876 Tue, 27 Jul 2010 06:24:23 +0100 3789876 http://www.medworm.com/index.php?rid=3789875&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F4%2F205%3Frss%3D1 Induction of hypothermia with the goal of providing therapeutic benefit has been accepted for use in the clinical setting of adult cardiac arrest and neonatal hypoxic-ischemic encephalopathy (HIE). However, its potential as a treatment in trauma is not as well defined. This review discusses potential benefits and complications of induced hypothermia (IH) with emphasis on the current state of knowledge and practice in various types of trauma. There is excellent preclinical research showing that in cases of penetrating trauma with cardiac arrest, inducing hypothermia to 10°C using cardiopulmonary bypass (CPB) could possibly save those otherwise likely to die without causing neurologic sequelae. A human trial of this intervention is about to get underway. Preclinical studies suggest that ... Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=3789875 Tue, 27 Jul 2010 06:24:23 +0100 3789875 http://www.medworm.com/index.php?rid=3789874&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F4%2F187%3Frss%3D1 Physical and psychological distress is exceedingly common among critically ill patients and manifests generically as agitation. The dangers of over- and undertreatment of agitation have been well described, and the intensive care unit (ICU) physician must strike a balance in the fast-paced, dynamic ICU environment. Identification of common reversible etiologies for distress may obviate the need for pharmacologic therapy, but most patients receive some combination of sedative, analgesic, and neuroleptic medications during the course of their critical illness. As such, understanding key pharmacologic features of commonly used agents is critical. Structured protocols and objective assessment tools can optimize drug delivery and may ultimately improve patient outcomes by reducing ventilator da... Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=3789874 Tue, 27 Jul 2010 06:24:23 +0100 3789874 http://www.medworm.com/index.php?rid=3572620&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Freprint%2F25%2F3%2F179%3Frss%3D1 (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=3572620 Tue, 18 May 2010 07:53:08 +0100 3572620 http://www.medworm.com/index.php?rid=3572619&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F3%2F175%3Frss%3D1 We report a case of cardiac tamponade in a patient with DF and lupus nephritis. We describe the characteristic features to differentiate pericardial effusion of lupus origin from that of viral etiology. A 59-year-old Hispanic woman presented to the emergency department with complaints of 5 to 6 days of fever, myalgia, headache, and retro-orbital pain. Her symptoms started 3 days after returning from the Dominican Republic, where a dengue outbreak was reported. Her past medical history was significant for hypertension and lupus nephritis diagnosed 3 months earlier. On day 2, patient developed a large pericardial effusion that progressed to tamponade over the next 2 days, requiring surgical drainage. Subsequently, the patient improved; however, serological analysis did not suggest any lupus ... Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=3572619 Tue, 18 May 2010 07:53:08 +0100 3572619 http://www.medworm.com/index.php?rid=3572618&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F3%2F172%3Frss%3D1 We report a case of a 64-year-old Puerto Rican gentleman treated chronically with corticosteroids for reactive airway disease, who presented to our institution with pancreatitis complicated by sepsis and acute lung injury requiring mechanical ventilation. The initial working diagnosis was gallstone pancreatitis; however, several days into his hospital course, he was found to have a history of strongyloidiasis. Subsequent examination of his stool revealed the parasite, and the patient was treated with ivermectin. This case highlights the occasional association between pancreatitis and strongyloidiasis and the importance of proper treatment and consideration of infection in patients from endemic regions, which include Central America, Africa, and Asia. (Source: Journal of Intensive Care Medi... Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=3572618 Tue, 18 May 2010 07:53:08 +0100 3572618 http://www.medworm.com/index.php?rid=3572617&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F3%2F168%3Frss%3D1 Conclusions: A helium—oxygen mixture decreases resistance to gas flow during bronchoscopy through an LMA in infants and children receiving general anesthesia with sevoflurane and pressure support ventilation. (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=3572617 Tue, 18 May 2010 07:53:08 +0100 3572617 http://www.medworm.com/index.php?rid=3572616&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F3%2F163%3Frss%3D1 Conclusion: Tissue Doppler indices using TTE is a feasible and strong predictor of PAWP in patients with septic shock. (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=3572616 Tue, 18 May 2010 07:53:08 +0100 3572616 http://www.medworm.com/index.php?rid=3572615&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F3%2F156%3Frss%3D1 Conclusions:The primary mission of a US military ICU deployed in support of combat operations is the care of its injured troops. However, the 10th CSH deployed in an urban region of Iraq in a mature theater of operations and its ICU more commonly cared for non-US patients during combat medical operations. These patients included pediatric patients as well as admissions for nontrauma illnesses. This mission was accomplished by nurses and physicians faced with unique challenges and resulted in an acceptable ICU mortality rate. (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=3572615 Tue, 18 May 2010 07:53:08 +0100 3572615 http://www.medworm.com/index.php?rid=3572614&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F3%2F149%3Frss%3D1 Conclusion: Variation and lack of availability of key processes for care of critically ill patients in this population identifies opportunities for knowledge translation and systematic improvement including regionalization of care. (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=3572614 Tue, 18 May 2010 07:53:08 +0100 3572614 http://www.medworm.com/index.php?rid=3572613&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F3%2F139%3Frss%3D1 The kidney is able to rapidly eliminate many water-soluble xenobiotics (exogenous chemicals). However, in the face of extraordinary serum concentrations of these xenobiotics or renal dysfunction, alternative elimination techniques often become necessary. Extracorporeal removal (ECR) techniques are used to increase the clearance of xenobiotics. These techniques include hemodialysis (HD), charcoal hemoperfusion (HP), and modalities grouped under the heading of continuous renal replacement therapy (CRRT): continuous venovenous hemofiltration (CVVH) and continuous venovenous hemodiafiltration (CVVHDF). Extracorporeal removal is limited to patients with significant or potentially significant clinical poisoning because the resources required to perform ECR are great. Therefore, most patients who... Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=3572613 Tue, 18 May 2010 07:53:08 +0100 3572613 http://www.medworm.com/index.php?rid=3572612&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F3%2F131%3Frss%3D1 The majority of nosocomial bloodstream infections in critically ill patients originate from an infected central venous catheter (CVC). Catheter-related bloodstream infections (CRBSIs) cause significant morbidity and mortality and increase the cost of care. The most frequent causative organisms for CRBSI are coagulase-negative staphylococci (CoNSs), Staphylococcus aureus, enterococci, and Candida species. The path to infection frequently includes migration of skin organisms at the insertion site into the cutaneous catheter tract, resulting in microbial colonization of the catheter tip and formation of biofilm. Evidence-based strategies for the prevention of CRBSI include behavioral and educational interventions, effective skin antisepsis coupled with maximum barrier precautions, the use of ... Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=3572612 Tue, 18 May 2010 07:53:08 +0100 3572612 http://www.medworm.com/index.php?rid=3402584&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Freprint%2F25%2F2%2F121%3Frss%3D1 (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=3402584 Thu, 25 Mar 2010 06:43:05 +0100 3402584 http://www.medworm.com/index.php?rid=3402583&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F2%2F117%3Frss%3D1 Conclusion: Rosiglitazone may assist glycemic control in the ICU. Despite recent concerns of cardiac safety, further research should be done to evaluate its potential as a short-term therapeutic agent in the ICU, given its anti-inflammatory and antishock profile. (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=3402583 Thu, 25 Mar 2010 06:43:05 +0100 3402583 http://www.medworm.com/index.php?rid=3402582&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F2%2F111%3Frss%3D1 Conclusion: Postoperative ScvO2 can be a valuable tool to predict OD after major cardiac surgeries. Its kinetics should be carefully followed in that setting. (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=3402582 Thu, 25 Mar 2010 06:43:05 +0100 3402582 http://www.medworm.com/index.php?rid=3402581&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F2%2F104%3Frss%3D1 Conclusions: Because of the high agreement between a normal aVBG with a normal ABG and the small bias between these tests, we recommend use of the adjusted central VBG. (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=3402581 Thu, 25 Mar 2010 06:43:05 +0100 3402581 http://www.medworm.com/index.php?rid=3402580&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F2%2F93%3Frss%3D1 Malaria remains a major health problem in much of Asia and Africa. A steady number of cases of imported malaria are also seen in many countries of the developed world. Plasmodium falciparum malaria and to some extent malaria caused by other species of Plasmodium can lead to many complications such as acute respiratory distress syndrome (ARDS), cerebral malaria, acute renal failure, severe anemia, thrombocytopenia, and bleeding complications. About 10% of patients with severe malaria die, usually as a result of multiorgan dysfunction. Critical care physicians should be aware of the complications and management of severe malaria. There has been significant progress in the understanding of pathogenesis of severe malaria over the last decade. Effective management of severe malaria includes ear... Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=3402580 Thu, 25 Mar 2010 06:43:05 +0100 3402580 http://www.medworm.com/index.php?rid=3402579&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F2%2F78%3Frss%3D1 Invasive fungal infections are major causes of morbidity and mortality in critically ill patients. Foremost among these is invasive candidiasis. In recent years, invasive aspergillosis (IA) and zygomycosis have emerged as major problems in susceptible, critically ill patients. Risk factors for invasive fungal infections, including disrupted anatomic barriers, suppressed antifungal host responses, and exposure to potentially opportunistic fungi are common in critically ill patients. The expanded antifungal armamentarium and advent of rapid diagnostic techniques are altering the approach to invasive fungal infections in the intensive care unit (ICU). Herein, we review recent developments in the field of antifungal host defenses, the changing epidemiology of fungal infections in the ICU, the ... Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=3402579 Thu, 25 Mar 2010 06:43:05 +0100 3402579 http://www.medworm.com/index.php?rid=3402578&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F2%2F71%3Frss%3D1 Thyrotoxic periodic paralysis (TPP) is an unusual complication of hyperthyroidism that frequently presents in a dramatic fashion, necessitating treatment in an emergency department or admission to an intensive care unit. Thyrotoxic periodic paralysis is characterized by transient, recurrent episodes of flaccid muscle paralysis affecting proximal more severely than distal muscles. Thyrotoxic periodic paralysis is most commonly a complication of Graves’ disease in Asian males, although in recent decades, an increasing number of patients from all racial and ethnic backgrounds have been reported. Thyrotoxic periodic paralysis has a higher predilection for men than women despite the fact that thyroid disease is more frequently diagnosed in women. The presence of both hypokalemia and eleva... Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=3402578 Thu, 25 Mar 2010 06:43:05 +0100 3402578 http://www.medworm.com/index.php?rid=3184629&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Freprint%2F25%2F1%2F67%3Frss%3D1 (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=3184629 Tue, 19 Jan 2010 09:30:41 +0100 3184629 http://www.medworm.com/index.php?rid=3184628&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Freprint%2F25%2F1%2F65%3Frss%3D1 (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=3184628 Tue, 19 Jan 2010 09:30:41 +0100 3184628 http://www.medworm.com/index.php?rid=3184627&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F1%2F53%3Frss%3D1 We report a case of an infant with absent brain blood flow on an anterior planar image despite persistent breathing and extensor posturing. We reviewed the literature from 1980 to 2008 using MEDLINE and PubMed to determine the sensitivity and specificity of these tests in the diagnosis of BD. Search terms were any combination of: brain death; and single photon emission computed tomography (SPECT), radiopharmaceuticals, technetium Tc 99m exametazime, or organotechnetium compounds. The sensitivity of absent brain blood flow on planar imaging for clinically confirmed BD is 119/153 = 77.8% [95% CI 70.5%—83.7%]; and the specificity is 41/41 (100%) [95% CI 92.6%—100%]. For clinically confirmed BD, the sensitivity of SPECT is 107/121 (88.4%) [95% CI 81.4%—93.1%], and specificity... Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=3184627 Tue, 19 Jan 2010 09:30:41 +0100 3184627 http://www.medworm.com/index.php?rid=3184626&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F1%2F46%3Frss%3D1 Conclusion: There was a national variation in ICU consent practices with an interest in a wider usage of universal consent protocols. The latter was adopted differentially based on patient demographics. Universal consent was widely accepted at our institution. (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=3184626 Tue, 19 Jan 2010 09:30:41 +0100 3184626 http://www.medworm.com/index.php?rid=3184625&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F1%2F39%3Frss%3D1 Conclusion: Chronic lung disease, subglottic stenosis, and combinations are the most common causes for tracheostomy at present followed for tracheostomy due to neurological problems. Children requiring tracheostomy have lengthy hospital stay. Establishing an accurate diagnosis helps predict the length of hospitalization and the need for home ventilation; however, in less clear cases, the length of stay can be predicted from the presence of pulmonary hypertension, reflux, and failure to thrive. The mortality rate is low at the postoperative period and increases depending upon the underline reason for tracheostomy referral. (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=3184625 Tue, 19 Jan 2010 09:30:41 +0100 3184625 http://www.medworm.com/index.php?rid=3184624&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F1%2F31%3Frss%3D1 Conclusions: The circadian rhythm of blood glucose control confirmed in our pre-IIT cohort was lost after institution of IIT. The morning blood glucose value appears to be a reasonable surrogate of overall glycemic control in a critically ill population on IIT, although this may vary based on the degree of control achieved. The QDC method is useful for analyzing glycemic control in patients on IIT. (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=3184624 Tue, 19 Jan 2010 09:30:41 +0100 3184624 http://www.medworm.com/index.php?rid=3184623&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F1%2F23%3Frss%3D1 Clostridium difficile infection (CDI) is an increasing nosocomial problem in North America and Western Europe, where outbreaks caused by a more virulent, toxin-hyperproducing strain have been recently reported. Clostridium difficile infection is now characterized by a higher incidence, more frequent relapses, and a higher case-fatality ratio. As a consequence, fulminant cases requiring admission to the intensive care unit (ICU) are much more common than previously. In recent years, metronidazole has appeared to lose some of its effectiveness in CDI management and vancomycin is now recognized as the first-line treatment of severe cases. Rapid diagnosis and institution of infection control measures are critical components of CDI management. The current review focuses on recent changes in the... Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=3184623 Tue, 19 Jan 2010 09:30:41 +0100 3184623 http://www.medworm.com/index.php?rid=3184622&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F1%2F16%3Frss%3D1 Tele-intensive care unit (ICU) is a care provided to critically ill patients by off-site clinicians using audio, video, and electronic links to leverage technical, informational, and clinical resources. Providing care includes the ability to detect patient’s instability or laboratory abnormalities in real-time, collect additional clinical information from or about the patient, order diagnostic testing, make diagnoses, implement treatment, render other forms of intensive care such as managing life-support devices, and communicate with patients and bedside providers. This review summarizes how tele-ICU services are delivered, the alternative approaches that have been used, and summarizes published reports of its effects on patient-focused outcomes. Tele-ICU is thought to have great pro... Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=3184622 Tue, 19 Jan 2010 09:30:41 +0100 3184622 http://www.medworm.com/index.php?rid=3184621&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F1%2F3%3Frss%3D1 Asthma remains a troubling health problem despite the availability of effective treatment. A small but significant number of asthmatics experience life-threatening attacks culminating in intensive care unit admission. Standard treatment includes high dose systemic corticosteroids and inhaled bronchodilators. Patients with especially severe attacks may develop respiratory failure and need endotracheal intubation and mechanical ventilation. Severe airway obstruction may lead to dynamic hyperinflation and the possibility of hemodynamic collapse and barotrauma. Fortunately, most intubated asthmatics survive if physicians adhere to key management principles intended to avoid or minimize hyperinflation. The purpose of this review is to discuss the pathogenesis of life-threatening asthma and to p... Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=3184621 Tue, 19 Jan 2010 09:30:40 +0100 3184621 http://www.medworm.com/index.php?rid=3007063&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Freprint%2F24%2F6%2F395%3Frss%3D1 (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=3007063 Thu, 19 Nov 2009 07:09:05 +0100 3007063 http://www.medworm.com/index.php?rid=3007062&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Freprint%2F24%2F6%2F393%3Frss%3D1 (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=3007062 Thu, 19 Nov 2009 07:09:05 +0100 3007062 http://www.medworm.com/index.php?rid=3007061&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F6%2F389%3Frss%3D1 Care of the brain-dead patient is common in intensive care practice. Aggressive donor management is advocated to increase supply of viable organs. Significant controversy exists over cardiac resuscitation in patients determined dead by cardiac criteria. The issue, till now, has not been addressed in brain dead patients. We discuss a case of cardiac resuscitation of a brain-dead donor to ensure organ donation. This case allows us to examine the use of brain death criteria to declare death, the controversy regarding cardiac resuscitation in organ donor patients, and the standards for use of cardiac resuscitation in the organ donor declared dead by brain death criteria. The consent process for organ donation in brain dead patients should address the possibility of subsequent cardiac arrest. (... Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=3007061 Thu, 19 Nov 2009 07:09:05 +0100 3007061 http://www.medworm.com/index.php?rid=3007060&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F6%2F383%3Frss%3D1 The aim of the study was to describe our experience with bi-level positive airway pressure (BiPAP) ventilation in oncology children with acute respiratory failure, hospitalized in a single tertiary pediatric tertiary center. This was a retrospective cohort study of all pediatric oncology patients in our center admitted to the intensive care unit with acute hypoxemic or hypercarbic respiratory failure from January 1999 through May 2006, who required mechanical ventilation with BiPAP. Fourteen patients met the inclusion criteria with a total of 16 events of respiratory failure or impending failure: 12 events were hypoxemic, 1 was combined hypercarbic and hypoxemic, and 3 had severe respiratory distress. Shortly after BiPAP ventilation initiation, there was a statistically significant improve... Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=3007060 Thu, 19 Nov 2009 07:09:05 +0100 3007060 http://www.medworm.com/index.php?rid=3007059&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F6%2F376%3Frss%3D1 Conclusions: A transient decrease in mean BP was observed during the RM, and its degree was correlated with the preload decrease, while cardiac contractility was maintained. (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=3007059 Thu, 19 Nov 2009 07:09:05 +0100 3007059 http://www.medworm.com/index.php?rid=3007058&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F6%2F372%3Frss%3D1 This study suggests that clinicians should have a low threshold for ordering a CT scan in MICU patients with acute neurological dysfunction. (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=3007058 Thu, 19 Nov 2009 07:09:05 +0100 3007058 http://www.medworm.com/index.php?rid=3007057&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F6%2F361%3Frss%3D1 The potent inhalational anesthetic agents are used on a daily basis to provide intraoperative anesthesia. Given their beneficial effects on airway tone and reactivity, they also have a role in the treatment of status asthmaticus that is refractory to standard therapy. Although generally not of clinical significance, these agents can affect various physiological functions. The potent inhalational anesthetic agents decrease mean arterial pressure and myocardial contractility. The decrease in mean arterial pressure reduces renal and hepatic blood flow. Secondary effects on end-organ function may result from the metabolism of these agents and the release of inorganic fluoride. The following article reviews the history of inhalational anesthesia, the physical structure of the inhalational anest... Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=3007057 Thu, 19 Nov 2009 07:09:05 +0100 3007057 http://www.medworm.com/index.php?rid=3007056&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F6%2F352%3Frss%3D1 Intravascular volume status and volume responsiveness continue to be important questions for the management of critically ill or injured patients. Goal-directed hemodynamic therapy has been shown to be of benefit to patients with severe sepsis and septic shock, acute lung injury and adult respiratory distress syndrome, and for surgical patients in the operating room. Static measures of fluid status, central venous pressure (CVP), and pulmonary artery occlusion pressure (PAOP) are not useful in predicting volume responsiveness. Stroke volume variation and pulse pressure variation related to changes in stroke volume during positive pressure ventilation predict fluid responsiveness and represent an evolving practice for volume management in the intensive care unit (ICU) or operating room. Ado... Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=3007056 Thu, 19 Nov 2009 07:09:05 +0100 3007056 http://www.medworm.com/index.php?rid=3007055&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F6%2F347%3Frss%3D1 Hyponatremia is one of the newer and emerging risk factors for an adverse prognosis in chronic heart failure. Why decreased serum sodium is associated with worse prognosis remains unclear. It may reflect worsening heart failure and the deleterious effects of activation of neurohormones. The mechanism of hyponatremia in heart failure also remains unclear. A relatively greater degree of free-water retention compared to sodium retention is probably the major mechanism. The treatment of significant hyponatremia in heart failure is difficult. The conventional treatments such as fluid restriction, infusion of hypertonic saline, and aggressive diuretic therapies are not usually effective. Vasopressin receptor antagonists have been shown to enhance aquaresis and correct hyponatremia. However, long... Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=3007055 Thu, 19 Nov 2009 07:09:05 +0100 3007055 http://www.medworm.com/index.php?rid=2806603&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Freprint%2F24%2F5%2F338%3Frss%3D1 (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=2806603 Thu, 17 Sep 2009 23:00:00 +0100 2806603 http://www.medworm.com/index.php?rid=2806602&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F5%2F329%3Frss%3D1 Fluid replacement is considered the cornerstone of resuscitation in the ICU. However, only about 50% of critically ill hemodynamically unstable patients are fluid responsive; furthermore, both under-resuscitation and overzealous fluid administration adversely affect outcome Consequently, the resuscitation of critically ill patients requires an accurate assessment of the patients’ intravascular volume status and their volume responsiveness. This paper reviews the evolution and accuracy of methods for assessing fluid responsiveness in critically ill patients. (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=2806602 Thu, 17 Sep 2009 23:00:00 +0100 2806602 http://www.medworm.com/index.php?rid=2806601&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F5%2F323%3Frss%3D1 Conclusion: Our study indicates that high-flow nasal cannula improves the respiratory scale score, the oxygen saturation, and the patient’s COMFORT scale. Its mechanism of action is application of mild positive airway pressure and lung volume recruitment. (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=2806601 Thu, 17 Sep 2009 23:00:00 +0100 2806601 http://www.medworm.com/index.php?rid=2806600&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F5%2F317%3Frss%3D1 Conclusions: Fever in critically ill children occurs frequently during PICU stay. Fever after 48 hours of admission or new episodes of fever after 48 nonfebrile hours were mainly caused by nosocomial infections and was independently associated with prolonged length of ventilatory support and PICU stay. (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=2806600 Thu, 17 Sep 2009 23:00:00 +0100 2806600 http://www.medworm.com/index.php?rid=2806599&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F5%2F293%3Frss%3D1 The term ‘‘adrenergic’’ originates from ‘‘adrenaline’’ and describes hormones or drugs whose effects are similar to those of epinephrine. Adrenergic stress is mediated by stimulation of adrenergic receptors and activation of post-receptor pathways. Critical illness is a potent stimulus of the sympathetic nervous system. It is undisputable that the adrenergic-driven ‘‘fight-flight response’’ is a physiologically meaningful reaction allowing humans to survive during evolution. However, in critical illness an overshooting stimulation of the sympathetic nervous system may well exceed in time and scope its beneficial effects. Comparable to the overwhelming immune response during sepsis, adrenergic stress in critical illness... Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=2806599 Thu, 17 Sep 2009 23:00:00 +0100 2806599 http://www.medworm.com/index.php?rid=2806598&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F5%2F283%3Frss%3D1 Endotracheal tube (ETT) insertion is the primary method of definitive airway protection and control in critically ill patients. Detection of ETT malposition in a timely fashion is crucial in both elective and emergent intubation. In this review, we describe classic tests and highlight several new technologies that may assist the practitioner in determining ETT position within the esophago-tracheal complex, namely ultrasonographic and impedance-based methods. Strengths and weaknesses of particular methods are highlighted. Although many physical examination maneuvers have been described, reliance on the physical examination alone is insufficient for confirmation. Touted methods that appear failsafe, such as direct visualization of the ETT traversing the vocal cords have limitations, especial... Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=2806598 Thu, 17 Sep 2009 23:00:00 +0100 2806598 http://www.medworm.com/index.php?rid=2624856&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Freprint%2F24%2F4%2F278%3Frss%3D1 (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=2624856 Mon, 20 Jul 2009 23:00:00 +0100 2624856 http://www.medworm.com/index.php?rid=2624855&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F4%2F273%3Frss%3D1 We describe an adolescent with acute leukemia who presented to the operating room for placement of a Broviac catheter for permanent central venous access. Given a persistently low oxygen saturation as measured by pulse oximetry (92% to 94%) with no response to changes in the inspired oxygen concentration and the lack of physical findings on auscultation to explain the low oxygen saturation, the diagnosis of metHb was entertained and confirmed by laboratory analysis. (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=2624855 Mon, 20 Jul 2009 23:00:00 +0100 2624855 http://www.medworm.com/index.php?rid=2624854&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F4%2F269%3Frss%3D1 We report a case of a patient with idiopathic thrombocytopenic purpura (ITP) who developed massive cerebral ischemia due to this entity. Prompt and aggressive treatment may prevent and actually resolve lethal complications caused by this devastating syndrome. (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=2624854 Mon, 20 Jul 2009 23:00:00 +0100 2624854 http://www.medworm.com/index.php?rid=2624853&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F4%2F261%3Frss%3D1 Bladder pressure measurement through a foley catheter is the current standard in monitoring for intraabdominal hypertension (IAH) and abdominal compartment syndrome (ACS). Accurate pressure transduction requires a continuous fluid column with a small volume of transducing medium at the tip of the catheter. Infusing excessive fluid volume can falsely elevate the measured intra-abdominal pressure (IAP) due to bladder overdistention and can lead to intrinsic muscular contraction. This effect can be seen with volumes as low as 60 mL. Recent expert consensus has recommended 25 mL as the maximal infusion volume; however, 50 mL is the most commonly cited volume of infusion in the literature. The purpose of this analysis was to determine the variance between IAP values using a range of volume infu... Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=2624853 Mon, 20 Jul 2009 23:00:00 +0100 2624853 http://www.medworm.com/index.php?rid=2624852&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F4%2F252%3Frss%3D1 Conclusions: Lipid hydroperoxides are formed in PN solutions and increase further following irradiation. This is associated with a significant reduction in vitamin E and antioxidant potential. The increase in urinary isoprostanes indicates a potentially proinflammatory effect of irradiated PN. (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=2624852 Mon, 20 Jul 2009 23:00:00 +0100 2624852 http://www.medworm.com/index.php?rid=2624851&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F4%2F242%3Frss%3D1 Conclusions: There was a large amount of variation in insulin resistance, as measured by an adapting multiplier, both across the population and within patients. In the setting of tight glucose control measures of glucose control (median blood glucose and percent in range) do not differentiate between patients who lived and died while measures of insulin resistance (median insulin dose and multiplier) do, suggesting that the insulin resistance is a better predictor of outcome. (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=2624851 Mon, 20 Jul 2009 23:00:00 +0100 2624851 http://www.medworm.com/index.php?rid=2624850&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F4%2F230%3Frss%3D1 Inadequate initial antimicrobial treatment in serious infections leads to increased mortality. Achieving adequate treatment is increasingly difficult because of the increasing prevalence of multidrug-resistant (MDR) pathogens. The carbapenems are potent, broad-spectrum antibiotics that have been shown to be safe and efficacious therapies in the treatment of serious infections. This review is intended to compare the 4 major members of the carbapenem class, which include imipenem, meropenem, ertapenem, and doripenem, with other widely used antimicrobial agents in the intensive care unit (ICU). The carbapenems are potent, broad-spectrum antibiotics that have been shown to be safe and efficacious therapies in the treatment of serious infections. They provide better gram-negative coverage than ... Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=2624850 Mon, 20 Jul 2009 23:00:00 +0100 2624850 http://www.medworm.com/index.php?rid=2624849&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F4%2F215%3Frss%3D1 Despite advances in ventilator management, 31% to 38% of patients with adult respiratory distress syndrome (ARDS) will die, some from progressive respiratory failure. Inability to adequately oxygenate patients with severe ARDS has prompted extensive efforts to identify what are now known as alternative modes of ventilation including high-frequency oscillatory ventilation and airway pressure release ventilation. Both modalities are based on the principles of the open-lung concept and aim to improve oxygenation by keeping the lung uniformly inflated for an extended period of time. Although a mortality benefit has not been proven, some patients may benefit from these alternative modes of ventilation as rescue measures while the underlying process resolves. The purpose of this article is to re... Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=2624849 Mon, 20 Jul 2009 23:00:00 +0100 2624849 http://www.medworm.com/index.php?rid=2426574&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Freprint%2F24%2F3%2F210%3Frss%3D1 (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=2426574 Thu, 21 May 2009 04:00:00 +0100 2426574 http://www.medworm.com/index.php?rid=2426573&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Freprint%2F24%2F3%2F208%3Frss%3D1 (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=2426573 Thu, 21 May 2009 04:00:00 +0100 2426573 http://www.medworm.com/index.php?rid=2426571&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F3%2F205%3Frss%3D1 Conclusion: While Kombucha tea is considered a healthy elixir, the limited evidence currently available raises considerable concern that it may pose serious health risks. Consumption of this tea should be discouraged, as it may be associated with life-threatening lactic acidosis. (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=2426571 Thu, 21 May 2009 04:00:00 +0100 2426571 http://www.medworm.com/index.php?rid=2426570&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F3%2F200%3Frss%3D1 We present a case of Strongyloides stercoralis hyperinfection in a 30-year-old HIV positive female who presents with diffuse alveolar hemorrhage. We discuss the relevant differential diagnoses and characteristic imaging findings. (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=2426570 Thu, 21 May 2009 04:00:00 +0100 2426570 http://www.medworm.com/index.php?rid=2426569&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F3%2F195%3Frss%3D1 This study introduces the design and construction of a mattress insert to produce more effective cardiopulmonary resuscitation (CPR). The mattress insert deflates, making the mattress insert a rigid surface. Using a device that administers a constant compression depth onto a manikin, we were able to show that our mattress insert more effectively directed the compressive force to the manikin compared to the current practice of using a headboard on top of a mattress. The mattress insert produced a statistically significant increase in the compression efficiency when compared to the current practice of using the headboard (81% vs. 53%). Because the mattress insert starts deflating immediately after the vacuum is turned on, 1 person is needed to initiate chest compressions. Compression begins ... Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=2426569 Thu, 21 May 2009 04:00:00 +0100 2426569 http://www.medworm.com/index.php?rid=2426568&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F3%2F187%3Frss%3D1 Conclusions: Decannulation was achieved in 35% of patients transferred to an LTAC for weaning from prolonged mechanical ventilation. (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=2426568 Thu, 21 May 2009 04:00:00 +0100 2426568 http://www.medworm.com/index.php?rid=2426566&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F3%2F179%3Frss%3D1 Conclusion: CATH is more likely to be performed in certain patients and identifies a significant number of high-grade stenoses in this population. Receiving CATH was independently associated with good outcome. (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=2426566 Thu, 21 May 2009 04:00:00 +0100 2426566 http://www.medworm.com/index.php?rid=2426565&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F3%2F168%3Frss%3D1 Decompressive surgery has since long been a promising therapeutic approach for patients with acute severe brain injury at risk to develop severe brain edema. The underlying rationale of removing part of the cranium is to create space for the expanding brain to prevent secondary damage to vital brain tissue. However, until recently, randomized controlled trials that demonstrate the efficacy of decompressive surgery or benefit for outcome were missing. This has changed since the results of 3 randomized trials on hemicraniectomy in malignant infarction of the middle cerebral artery have been published in 2007. In this article, the current evidence for decompressive surgery in the treatment of cerebral ischemia, intracranial hemorrhage, traumatic brain injury, inflammatory diseases, or severe ... Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=2426565 Thu, 21 May 2009 04:00:00 +0100 2426565 http://www.medworm.com/index.php?rid=2426564&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F3%2F151%3Frss%3D1 This article provides a review of biologic markers in acute lung injury, with an emphasis on recent analysis of results from multicenter clinical trials. (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=2426564 Thu, 21 May 2009 04:00:00 +0100 2426564 http://www.medworm.com/index.php?rid=2281832&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Freprint%2F24%2F2%2F148%3Frss%3D1 (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=2281832 Wed, 18 Mar 2009 04:00:00 +0100 2281832 http://www.medworm.com/index.php?rid=2281831&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F2%2F144%3Frss%3D1 We report a ``medical intensivist's'' experience with the placement of 13 percutaneous vena cava filters. Vena cava filters were successfully placed in 12 of 13 patients as confirmed by postplacement venacavograms; 1 placement attempt was aborted because of a completely occluded inferior vena cava. These results suggest that with appropriate training and supervision, medical intensivists can safely insert vena cava filters in the intensive care unit setting. Such a practice appears safe, reduces patient risk associated with intrahospital transport, and may promote cost containment. (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=2281831 Wed, 18 Mar 2009 04:00:00 +0100 2281831 http://www.medworm.com/index.php?rid=2281830&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F2%2F140%3Frss%3D1 A 39-year-old diabetic male sustained 4 culture-proven episodes of disseminated Mycobacterium avium complex infection over a span of 6 years. The first, second, and fourth episodes were manifested clinically by osteomyelitis. The third episode was characterized by Mycobacterium avium complex septicemia (positive blood cultures for Mycobacterium avium complex) and acute respiratory failure with features of acute respiratory distress syndrome requiring mechanical ventilation and positive end-expiratory pressure for up to 30 days. Studies for impaired immunity including human immunodeficiency virus infection, idiopathic CD4+ T lymphocytopenia syndrome, and interferon deficiency were negative. Intensive treatment of the fourth episode with amikacin, clarithromycin, rifampin, isoniazide, ethamb... Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=2281830 Wed, 18 Mar 2009 04:00:00 +0100 2281830 http://www.medworm.com/index.php?rid=2281829&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F2%2F131%3Frss%3D1 Fever has been shown to be related to extended hospital stays in neurologically injured patients. We performed meta-analyses of the impact of fever on length of stay (LOS) in the Intensive Care Unit (ICU) and for total hospital length of stay, including all recent scholarship published since 1/1/1995 pertaining to thermoregulation of neurogenic fever and length of hospital stay. We also developed estimates of the financial impact on hospital costs. Fever was shown to have a large, statistically significant impact on both ICU and hospital LOS. For ICU LOS, combined effect size g = .88, Z = 4.24, P < .0001. For hospital LOS, g = .79, Z = 2.2, P = .0278. Mean additional ICU days = 5.7 days; mean additional hospital days = 8.5 days. We estimate that fever added an average of $17,414 in hosp... Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=2281829 Wed, 18 Mar 2009 04:00:00 +0100 2281829 http://www.medworm.com/index.php?rid=2281828&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F2%2F122%3Frss%3D1 Maintenance of spontaneous breathing superimposed on mechanical ventilation is suggested to improve gas exchange in patients with acute lung injury. The aim of this study was to evaluate the long-term effects of airway pressure release ventilation with maintained unsupported spontaneous breathing (APRV) and synchronized intermittent mandatory ventilation with pressure support (SIMV) on the amount of lung collapse in acute lung injury patients. Thirty-seven patients with acute lung injury were studied in a trial comparing APRV or SIMV. Computer-assisted tomography scannings (CT) were performed before randomization and at day 7. The change in the amount of nonaerated lung was comparable between groups; 14.7% (3.8-17.4) in APRV group (n = 13) and 9.6% (—1.4 to 18.62) in the SIMV group (... Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=2281828 Wed, 18 Mar 2009 04:00:00 +0100 2281828 http://www.medworm.com/index.php?rid=2281827&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F2%2F116%3Frss%3D1 Conclusions: Hemostasis occurred in 25 postoperative pediatric cardiac patients after recombinant activated Factor VII was given. In this setting, once conventional hemostatic therapy was optimized, recombinant activated Factor VII 180 µg/kg initially with intercostal losses greater than 10 mL/kg/h and a repeat dose after 2 hours if losses remained greater than 5 mL/kg/h was effective. No complications were found to have occurred and there was a coincidental reduction in annual returns to theatre for excessive bleeding. (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=2281827 Wed, 18 Mar 2009 04:00:00 +0100 2281827 http://www.medworm.com/index.php?rid=2281826&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F2%2F108%3Frss%3D1 The purpose of this study was to analyze the relationship of intrahospital transport patterns with patient throughput and outcomes in an oncological intensive care unit. We retrospectively reviewed all patients admitted to a closed medical-surgical intensive care unit at a cancer center between January 1, 2004 and December 31, 2005. We compared the clinical characteristics and outcomes of patients with and without transport and analyzed all intrahospital transports in relation to intensive care unit occupancy, length of stay, and intensive care unit and hospital outcomes. Transport patterns were also assessed by day of week, time of day, timing of the first transport to intensive care unit admission, and destination. Transported patients (n = 413, 43.5%) had significantly higher severity o... Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=2281826 Wed, 18 Mar 2009 04:00:00 +0100 2281826 http://www.medworm.com/index.php?rid=2281825&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F2%2F96%3Frss%3D1 Head injury remains a major cause of preventable death and serious morbidity in young adults. Based on the available evidence, it appears that a cerebral perfusion pressure of 50 to 70 mm Hg is generally adequate to ensure cerebral oxygen delivery and prevent ischemia. However, evidence suggests that perfusion requirements may not only vary across the injured brain but also differ depending on the time since injury. Such heterogeneity, both within and between subjects, suggests that individualized therapy may be an appropriate treatment strategy. Future studies should aim to assess which groups of patients, and what regional pathophysiological derangements, may benefit with improvements in functional outcome from therapeutic increases or decreases in cerebral perfusion pressure beyond thes... Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=2281825 Wed, 18 Mar 2009 04:00:00 +0100 2281825 http://www.medworm.com/index.php?rid=2281824&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F2%2F83%3Frss%3D1 This article will review important physiologic changes of aging, as well as sepsis and delirium and outcomes of older ICU patients. (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=2281824 Wed, 18 Mar 2009 04:00:00 +0100 2281824 http://www.medworm.com/index.php?rid=2106842&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F1%2F72%3Frss%3D1 We describe the clinical features of a patient with near-fatal heat stroke who was admitted to our intensive care unit. A 14-year-old girl became convulsive and hyperthermic when participating in a strenuous hike under direct sunlight in a hilly area in Venezuela on a very hot and humid day. During the following days, she developed multiple organ failure, including neurological impairment, acute renal failure, disseminated intravascular coagulation, and extensive hepatic and muscle damage. Treatment consisted of ventilatory support, hemodialysis, corticosteroids, and enteral nutrition. This case of multiple organ failure following near-fatal heat stroke illustrates that although there are no specific techniques and measures for the treatment of this condition, intensive care management and... Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=2106842 Wed, 14 Jan 2009 05:00:00 +0100 2106842 http://www.medworm.com/index.php?rid=2106841&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F1%2F63%3Frss%3D1 Conclusions: The diagnostic accuracy of procalcitonin was higher than C-reactive protein and complement proteins. Procalcitonin in combination with Sequential Organ Failure Assessment was useful to diagnose infection. C-reactive protein, Sequential Organ Failure Assessment score, age, and gender showed to be helpful to improve the prediction of mortality risk, but not procalcitonin. (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=2106841 Wed, 14 Jan 2009 05:00:00 +0100 2106841 http://www.medworm.com/index.php?rid=2106840&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F1%2F54%3Frss%3D1 Conclusions: The implementation of a simple, low-cost oral care protocol in the surgical intensive care unit led to a significantly decreased risk of acquiring ventilator-associated pneumonia. (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=2106840 Wed, 14 Jan 2009 05:00:00 +0100 2106840 http://www.medworm.com/index.php?rid=2106839&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F1%2F47%3Frss%3D1 Conclusions: Combined immunomodulatory therapy with ulinastatin plus thymosin 1 appears to yield improved survival for patients with sepsis; this finding should be verified in larger clinical trials. (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=2106839 Wed, 14 Jan 2009 05:00:00 +0100 2106839 http://www.medworm.com/index.php?rid=2106838&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F1%2F35%3Frss%3D1 Conclusions: Negative cumulative fluid balance at day 4 of acute lung injury is associated with significantly lower mortality, independent of other measures of severity of illness. (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=2106838 Wed, 14 Jan 2009 05:00:00 +0100 2106838 http://www.medworm.com/index.php?rid=2106837&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F1%2F26%3Frss%3D1 The most common infectious complication in critically ill patients is ventilator-associated pneumonia. Ventilator-associated pneumonia has significant morbidity and mortality, prolongs mechanical ventilation, and extends length of hospitalization. Despite its prevalence and impact, uniform diagnostic standards are lacking. The Centers for Disease Control, American Thoracic Society, and Infectious Diseases Society of America have recommended focus on improving preventive measures, establishing widely available and accurate diagnostic tools, and improving ventilator-associated pneumonia management with length of therapy guidelines. The purpose of this article is to review the evidence supporting the clinical pulmonary infection score as an adjunct to distinguish and detect clinically relevan... Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=2106837 Wed, 14 Jan 2009 05:00:00 +0100 2106837 http://www.medworm.com/index.php?rid=2106836&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F1%2F18%3Frss%3D1 Atrial fibrillation is a common problem following cardiac surgery. Atrial fibrillation occurs in 30% to 50% patients during postoperative period. Postoperative atrial fibrillation often results in increased length of hospital stay, increased cost of postoperative hospitalization, heart failure, and, less frequently, cerebrovascular accident and death. Because postoperative atrial fibrillation is such a significant problem, several studies have attempted to find a safe and effective treatment for its prevention. In this article, we review the evidence for various prophylactic therapies and make an attempt to answer the following: (1) Can postoperative atrial fibrillation be prevented? (2) Is prophylactic therapy for postoperative atrial fibrillation safe? (3) Does prevention of postoperativ... Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=2106836 Wed, 14 Jan 2009 05:00:00 +0100 2106836 http://www.medworm.com/index.php?rid=2106835&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F1%2F3%3Frss%3D1 There is a rapidly growing population of immunocompromised organ transplant recipients. These patients are at risk of a large variety of infections that have significant consequences on mortality, graft dysfunction, and graft loss. The diagnosis and treatment of these infections are facilitated by an understanding of the preoperative, perioperative, and postoperative risk factors; the typical pathogens; and their characteristic time of presentation. On the basis of these factors, we put forth an algorithm for diagnosing and treating suspected infections in solid organ transplant recipients. (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=2106835 Wed, 14 Jan 2009 05:00:00 +0100 2106835 http://www.medworm.com/index.php?rid=1973344&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Freprint%2F23%2F6%2F414%3Frss%3D1 (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=1973344 Wed, 19 Nov 2008 05:00:00 +0100 1973344 http://www.medworm.com/index.php?rid=1973342&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Freprint%2F23%2F6%2F412%3Frss%3D1 (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=1973342 Wed, 19 Nov 2008 05:00:00 +0100 1973342 http://www.medworm.com/index.php?rid=1973341&cid=s_28711_53_f&fid=28711&url=http%3A%2F%2Fjic.sagepub.com%2Fcgi%2Freprint%2F23%2F6%2F409%3Frss%3D1 (Source: Journal of Intensive Care Medicine) Journal of Intensive Care Medicine journals http://www.medworm.com/rss/comments.php?id=1973341 Wed, 19 Nov 2008 05:00:00 +0100 1973341