MedWorm: Intensive Care

Effects of unilateral decompressive craniectomy on patients with unilateral acute post-traumatic brain swelling after severe traumatic brain injury

Critical Care — Fri, 20 Nov 2009 00:00:00 +0100

Conclusions: Our data suggest that unilateral DC has superiority in lowering ICP, reducing the mortality rate and improving neurological outcomes over unilateral routine temporoparietal craniectomy. However, it increases the incidence of delayed intracranial hematomas and subdural effusion, some of which need secondary surgical intervention. These results provide information important for further large and multicenter clinical trials on the effects of DC in patients with acute post-traumatic BS.Trial registration: ISRCTN14110527 (Source: Critical Care)

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England Sees Improvement After Investing in ICU Changes

SCCM RSS News — Thu, 19 Nov 2009 20:21:48 +0100

Survival rates of patients in intensive care have jumped in England since the government boosted spending and reformed critical care services, according to a study published in the British Medical Journal. The Department of Health invested £300 million in 2000 to help fund a 35% increase in beds as well as to implement outreach services and adopt clinical guidelines. The move cut the risk of mortality in critical care units by 11.3% and reduced hospital mortality rates by 13.4%. The cost effectiveness of critical care also increased after 2000, partly as a result of outcomes improvements and smaller increases in the average length of stay. Read more from Reuters... (Source: SCCM RSS News)

Your Colleagues Are Seeking Protocols

SCCM RSS News — Thu, 19 Nov 2009 20:21:16 +0100

Discussion topics include Adult Critical Care, Pediatric Critical Care and Protocols... (Source: SCCM RSS News)

Make a Sweet Escape: Attend the Post-Congress Conference

SCCM RSS News — Thu, 19 Nov 2009 20:20:43 +0100

Enjoy an extended Congress by attending the Post-Congress Conference, Hyperglycemia and Critical Illness: Adaptive Response or Therapeutic Opportunity?, to be held in Key West, Florida, USA. A faculty of international experts will present a pro/con debate on the Normoglycaemia in Intensive Care Evaluation and Survival Using Glucose Algorithm Regulation (NICE-SUGAR) Study. The meeting also will feature case studies on insulin protocols and nutritional guidelines as well as interactive debates on glucose variability and achieving glycemic control. Audience participation will be encouraged to enhance the overall learning experience... (Source: SCCM RSS News)

Experience the Complete Congress Package

SCCM RSS News — Thu, 19 Nov 2009 20:20:10 +0100

Pre-register for the Society of Critical Care Medicine’s (SCCM) 39th Critical Care Congress by December 10, 2009. The five continuous days of educational sessions, hands-on workshops, interactive debates, and networking opportunities will provide you with effective solutions to the everyday challenges facing you and your team... (Source: SCCM RSS News)

AMA House of Delegates Address EOL, Healthcare Reform

SCCM RSS News — Thu, 19 Nov 2009 20:19:42 +0100

The American Medical Association’s House of Delegates last week met for its interim meeting to discuss the ongoing healthcare system debate. Representatives from the Society of Critical Care Medicine attended the meeting, where AMA President J. James Rohack, MD, reiterated the group’s support for the latest bills making their way through Congress, the Affordable Health Care for America Act and the Medicare Physician Payment Reform Act of 2009. Rohack noted the perceived shortcomings of the Affordable Health Care for America Act, namely its lack of coverage for everyone and concerns about access. He stressed that the AMA would continue to advocate for changes as the legislative process moves forward... (Source: SCCM RSS News)

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ISCCM Preparing a New Critical Care Workforce

SCCM RSS News — Thu, 19 Nov 2009 20:19:19 +0100

The Nagpur chapter of the Indian Society of Critical Care Medicine (ISCCM) recently was featured in the The Times of India for the group’s efforts to launch a new, hands-on critical care training program for resident and junior physicians, nurses and other members of the multiprofessional team. For many, this will be their first exposure to such training, as critical care management courses usually are not included in the Indian curriculum at the undergraduate or postgraduate levels... (Source: SCCM RSS News)

Get the First Articles from CCM's H1N1 Supplement

SCCM RSS News — Thu, 19 Nov 2009 20:18:59 +0100

A supplement to Critical Care Medicine focused on H1N1 influenza will be released next year, but open-access article proofs are being posted online as they become available, ensuring clinicians receive this information as soon as possible. Read the first supplement article available, "Infection control in mass respiratory failure: Preparing to respond to H1N1."... (Source: SCCM RSS News)

Study Investigates New Pulmonary Embolism Thrombolysis

SCCM RSS News — Thu, 19 Nov 2009 20:18:40 +0100

Researchers at Stanford have shown catheter-directed thrombolysis to be an effective procedure in first-line treatment for pulmonary embolism (PE). A meta-analysis published in the Journal of Vascular and Interventional Radiology found that, between 1990 and 2008, the procedure was successful in 86.5% of 594 patients who were at risk of dying of PE. Catheter-directed thrombolysis appeared effective and safer than injecting the high-dose thrombolytic drug into the bloodstream, which can cause bleeding in up to 20% of patients. By targeting blood clots directly, the catheter-based procedure was associated with only a 2.4% chance of major complications... (Source: SCCM RSS News)

Editorial Board

Journal of Critical Care — Thu, 19 Nov 2009 15:52:11 +0100

(Source: Journal of Critical Care)

Journal of Critical Care — Thu, 19 Nov 2009 15:52:11 +0100

(Source: Journal of Critical Care)

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Ranitidine is unable to maintain gastric pH levels above 4 in septic patients

Journal of Critical Care — Thu, 19 Nov 2009 15:52:11 +0100

Conclusions: Intravenous ranitidine was unable to maintain gastric pH above 4 in septic patients. All cases in the ranitidine group in whom pH remained above 4 had gastric hypotrophy or atrophy. Pantoprazole successfully maintained pH levels above 4. (Source: Journal of Critical Care)

Reviewers 2009

Journal of Critical Care — Thu, 19 Nov 2009 15:52:10 +0100

(Source: Journal of Critical Care)

Retractions: Guidance from the Committee on Publication Ethics

Journal of Critical Care — Thu, 19 Nov 2009 15:52:10 +0100

Journal editors should consider retracting a publication if: They have clear evidence that the findings are unreliable, either as a result of misconduct (eg, data fabrication) or honest error (eg, miscalculation or experimental error) (Source: Journal of Critical Care)

Journal of Critical Care — Thu, 19 Nov 2009 15:52:10 +0100

The authors of this book have taken it upon themselves to present many of the controversial issues that physicians treating the critically ill patient are often faced with. The sections are nicely organized by organ systems and address topics including support of failing organ systems, ventilator management, fluid resuscitation, and sepsis. More recent topics, such as tight glucose control and end-of-life issues, are discussed. Chapters are included on organizational, technological, and ethical considerations. Each chapter has been written by internationally renowned experts in their area and is presented in a clear, concise, and informative manner. (Source: Journal of Critical Care)

Effects of propofol and dexmedetomidine on indocyanine green elimination assessed with LİMON to patients with early septic shock: A pilot study

Journal of Critical Care — Thu, 19 Nov 2009 15:52:10 +0100

Conclusion: In our study, we found that neither propofol nor dexmedetomidine infusion affected hepatic blood flow. (Source: Journal of Critical Care)

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World Federation Update: Strategic Initiatives from Florence to Durban

Journal of Critical Care — Thu, 19 Nov 2009 15:52:05 +0100

The 10th Quadrennial Meeting of the World Federation of Societies of Intensive and Critical Care Medicine (WFSICCM) was held in Florence, Italy, last August 28 to September 1, 2009. Hosted by the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Therapy and led by the steering committee chaired by Luciano Gattinoni (Milan), and his associates A Raffaelo De Gaudio (Florence), Antonino Gullo (Catania), and Rosalba Tufano (Naples), the delegates represented 96 countries and numbered more than 2000. The meeting was co-sponsored by the World Federation of Critical Care Nurses and the World Federation of Pediatric Intensive and Critical Care Societies (WFPICCS); the increasing collaboration of national, international, and regional critical care societies has been an objective...

Neuroimaging in the Medical Intensive Care Unit: An Essential Complement to the Clinical Examination

Journal of Intensive Care Medicine — Thu, 19 Nov 2009 07:09:05 +0100

(Source: Journal of Intensive Care Medicine)

Respect for Persons: Beyond the Mortal World

Journal of Intensive Care Medicine — Thu, 19 Nov 2009 07:09:05 +0100

(Source: Journal of Intensive Care Medicine)

Circulatory Arrest in a Brain-Dead Organ Donor: Is the Use of Cardiac Compression Permissible?

Journal of Intensive Care Medicine — Thu, 19 Nov 2009 07:09:05 +0100

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. (...

Bi-Level Positive Airway Pressure Ventilation in Pediatric Oncology Patients With Acute Respiratory Failure

Journal of Intensive Care Medicine — Thu, 19 Nov 2009 07:09:05 +0100

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...

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Acute Hemodynamic Effects of Recruitment Maneuvers in Patients With Acute Respiratory Distress Syndrome

Journal of Intensive Care Medicine — Thu, 19 Nov 2009 07:09:05 +0100

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)

The Role of Head Computer Tomographic Scans on the Management of MICU Patients With Neurological Dysfunction

Journal of Intensive Care Medicine — Thu, 19 Nov 2009 07:09:05 +0100

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)

Inhalational Anesthesia: Basic Pharmacology, End Organ Effects, and Applications in the Treatment of Status Asthmaticus

Journal of Intensive Care Medicine — Thu, 19 Nov 2009 07:09:05 +0100

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...

A Simple Physiologic Algorithm for Managing Hemodynamics Using Stroke Volume and Stroke Volume Variation: Physiologic Optimization Program

Journal of Intensive Care Medicine — Thu, 19 Nov 2009 07:09:05 +0100

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...

Analytic Review: Hyponatremia in Heart Failure

Journal of Intensive Care Medicine — Thu, 19 Nov 2009 07:09:05 +0100

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...

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Severe Influenza A (H1N1)v in patients without any known risk factor

Critical Care — Thu, 19 Nov 2009 00:00:00 +0100

In Rello et al work 15 out of 32 critical pandemic flu patients did not have any risk factor. A further analysis in this subgroup of patients is needed. Antiviral treatment delay or any other management event differences perhaps were responsible for progressive illness. This data may help management in initial care of pandemic flu patients. (Source: Critical Care)

Presentation and management of critically ill patients with Influenza A (H1N1) influenza - a UK perspective

Critical Care — Thu, 19 Nov 2009 00:00:00 +0100

A report of the demographics, presentation and management of patients with influenza A (H1N1) in a general adult intensive care unit in the United Kingdom. (Source: Critical Care)

PTX3 as a potential biomarker of acute lung injury: supporting evidence from animal experimentation

Intensive Care Medicine — Wed, 18 Nov 2009 00:03:19 +0100

Conclusion These results support the clinical finding that PTX3 may be a useful biomarker to the reflect severity of lung injury and provide effective therapies. The interplay between PTX3 and TF could be a potential mechanism that mediates lung injury. Content Type Journal ArticleCategory ExperimentalDOI 10.1007/s00134-009-1720-0Authors Xiaolin He, University Health Network Latner Thoracic Surgery Research Laboratory, Toronto General Research Institute Toronto ON CanadaBing Han, University Health Network Latner Thoracic Surgery Research Laboratory, Toronto General Research Institute Toronto ON CanadaXiaohui Bai, University Health Network Latner Thoracic Surgery Research Laboratory, Toronto General Research Institute Toronto ON CanadaYu Zhang, University Health Network...

An intervention to decrease complications related to endotracheal intubation in the intensive care unit: a prospective, multiple-center study

Intensive Care Medicine — Wed, 18 Nov 2009 00:03:17 +0100

Conclusions The implementation of an intubation management protocol can reduce immediate severe life-threatening complications associated with intubation of ICU patients. Content Type Journal ArticleCategory OriginalDOI 10.1007/s00134-009-1717-8Authors Samir Jaber, Université Montpellier 1 Intensive Care Unit, Anesthesia and Critical Care Department B: DAR B, CHU de Montpellier, Saint Eloi Teaching Hospital 80 avenue Augustin Fliche 34295 Montpellier Cedex 5 FranceBoris Jung, Université Montpellier 1 Intensive Care Unit, Anesthesia and Critical Care Department B: DAR B, CHU de Montpellier, Saint Eloi Teaching Hospital 80 avenue Augustin Fliche 34295 Montpellier Cedex 5 FrancePhilippe Corne, Hôpital Gui-de-Chauliac Service de Réanimation Médicale Assistance Respira...

Effects of reducing beta-lactam antibiotic pressure on intestinal colonization of antibiotic-resistant gram-negative bacteria

Intensive Care Medicine — Wed, 18 Nov 2009 00:03:17 +0100

Conclusion A 35–39% reduction of β-lactam exposure was not associated with reduced acquisition of CRE, whereas a 243% increase of fluoroquinolone use increased acquisition of FCRE. Content Type Journal ArticleCategory OriginalDOI 10.1007/s00134-009-1714-yAuthors Saskia Nijssen, St. Elisabethziekenhuis Department of Medical Microbiology Hilvarenbeekse Weg 60 5022 GC Tilburg The NetherlandsAd Fluit, University Medical Center Utrecht Department of Medical Microbiology, Julius Center for Health Sciences and Primary Care Heidelberglaan 100 3584 CX Utrecht The NetherlandsDavid van de Vijver, Erasmus Medical Center Rotterdam Department of Virology Rotterdam The NetherlandsJanetta Top, University Medical Center Utrecht Department of Medical Microbiology, Julius Center for H...

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A successful new method for removal of a large foreign body from the airways of an ARDS patient

Intensive Care Medicine — Wed, 18 Nov 2009 00:03:15 +0100

Content Type Journal ArticleCategory CorrespondenceDOI 10.1007/s00134-009-1716-9Authors Veronique Leray, CHU Croix Rousse Medical Intensive Care Unit 103 grande rue de la Croix Rousse 69004 Lyon FrancePascale Nesme, Hôpital de la Croix Rousse, CHU de Lyon Service de Pneumologie Lyon FranceGuillaume Landry, Hôpital de la Croix Rousse, CHU de Lyon Service de Chirurgie ORL Lyon FranceBertrand Pons, Hôpital de la Croix Rousse, CHU de Lyon Service de Réanimation Médicale Lyon FranceJean-christian Pignat, Hôpital de la Croix Rousse, CHU de Lyon Service de Chirurgie ORL Lyon FranceClaude Guerin, Hôpital de la Croix Rousse, CHU de Lyon Service de Réanimation Médicale Lyon France Journal Intensive Care MedicineOnline ISSN 1432-1238Print ISSN 0342-4642 (Source: Intensive Care Med...

Prevention of acute kidney injury and protection of renal function in the intensive care unit

Intensive Care Medicine — Wed, 18 Nov 2009 00:03:15 +0100

Conclusions and recommendations Several measures are recommended, though none carries grade 1A. We recommend prompt resuscitation of the circulation with special attention to providing adequate hydration whilst avoiding high-molecular-weight hydroxy-ethyl starch (HES) preparations, maintaining adequate blood pressure using vasopressors in vasodilatory shock. We suggest using vasopressors in vasodilatory hypotension, specific vasodilators under strict hemodynamic control, sodium bicarbonate for emergency procedures administering contrast media, and periprocedural hemofiltration in severe chronic renal insufficiency undergoing coronary intervention. Content Type Journal ArticleCategory Expert PanelDOI 10.1007/s00134-009-1678-yAuthors Michael Joannidis, Medical Un...

Clinical guidelines for the protection of kidney function and prevention of acute kidney injury in the intensive care unit: common sense rather than magic bullets?

Intensive Care Medicine — Wed, 18 Nov 2009 00:03:14 +0100

Content Type Journal ArticleCategory EditorialDOI 10.1007/s00134-009-1683-1Authors Andrew Davenport, University College London Medical School UCL Center for Nephrology, Royal Free Campus Rowland Hill Street London NW3 2PF UK Journal Intensive Care MedicineOnline ISSN 1432-1238Print ISSN 0342-4642 (Source: Intensive Care Medicine)

SCCM Pod-119 PCCM: Does Fellowship Program Size and Rotations Affect Clinical and Research Time?

SCCM PodCast - iCritical Care — Tue, 17 Nov 2009 16:24:00 +0100

Wynne Morrison, MD, discusses an article published in the May issue of Pediatric Critical Care Medicine, which highlighted the results of a national survey of pediatric critical care medicine fellowship clinical and research time allocation. (Source: SCCM PodCast - iCritical Care)

The leading causes of death after burn injury in a single pediatric burn center

Critical Care — Tue, 17 Nov 2009 00:00:00 +0100

IntroductionSevere thermal injury is characterized by profound morbidity and mortality. Advances in burn and critical care, including early excision and grafting, aggressive resuscitation and advances in antimicrobial therapy have made substantial contributions to decrease morbidity and mortality. Despite these advances, death still occurs. Our aim was to determine the predominant causes of death in burned pediatric patients in order to develop new treatment avenues and future trajectories associated with increased survival. Methods: Primary causes of death were reviewed from 144 pediatric autopsy reports. Percentages of patients that died from anoxic brain injuries, sepsis, or multi-organ failure were calculated by comparing to the total number of deaths. Data was stratified by time (from...

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The Value of a Risk Model for Early-onset Candidemia

Critical Care — Mon, 16 Nov 2009 00:00:00 +0100

Blood stream infections from Candida species are associated with an increased length of stay, increased hospital costs, and higher mortality when compared to bacterial blood stream infections. Delayed or inappropriate therapy in candidemia leads to increased mortality, thus early recognition becomes paramount. With biomarkers showing promise, blood cultures still remain the gold standard but require 24-72 hours for growth. Thus, the reliance on epidemilogic risk factors for the initiation of empiric antifungal therapy provides the best method for early appropriate therapy. Shorr and colleagues have devised a risk score to identify patients with early onset candidemia as defined by positive blood cultures within 2 days of admission, thus allowing for the initiation of early appropriate anti...

Ventilator-induced endothelial activation and inflammation in the lung and distal organs

Critical Care — Mon, 16 Nov 2009 00:00:00 +0100

Conclusions: Our data implicate that MV causes endothelial activation and inflammation in mice without pre-existing pulmonary injury, both in the lung and distal organs. (Source: Critical Care)

Evaluation of modernisation of adult critical care services in England

NeLM - Intensive Care (ICU) — Fri, 13 Nov 2009 00:00:00 +0100

The objective was to evaluate the impact of a programme of transformation initiated in late 2000, key elements of which included funding for a 35% increase in the number of critical beds, the creation of 29 clinical networks, covering the whole country and sharing agreed protocols, and, within hospitals, the establishment of outreach services and the adoption of care bundles. The main findings reported were as follows (taken from the abstract): . In the six years after 2000, the risk of unit mortality adjusted for case mix fell by 11.3% and hospital ... (Source: NeLM - Intensive Care (ICU))

Sepsis and multiple organ failure represent a chaotic adaptation to severe stress which must be controlled at nano-scale

Critical Care — Thu, 12 Nov 2009 00:00:00 +0100

We claim that sepsis and multiple organ failure represent an adaptive process that aims a survival advantage. Dynamic nature of sepsis comprise all of the key properties of a chaotic system. Chaotic and complex systems actually aim order and integrity, and their behaviours cannot be explained by linear statistical methods. That's why pathophysiology of sepsis and multiple organ failure must be re-modeled within the context of chaos and complexity theories. We also claim that one of the underlying reasons of difficulty in bench to bedside transition of experimental data is the difficulty in applying therapies at the proposed level of action. This decreases the efficacy and safety of treatment. Application of tools provided by nanotechnology can serve to design better therapies that can appl...

Unraveling the Role of HMGB1 in Severe Trauma

Critical Care — Thu, 12 Nov 2009 00:00:00 +0100

High mobility group box protein (HMGB1) has been shown to participate in acute inflammatory reactions, including acute lung injury and sepsis. There is also evidence that circulating levels of HMGB1 are increased after severe trauma and are associated with clinically important outcome parameters, including mortality. Recent studies demonstrated that HMGB1 itself has little or no proinflammatory activity, but is able to potentiate inflammatory responses through binding to mediators, such as endotoxin or cytokines. Important questions are to determine the binding partners for HMGB1 in the setting of severe injury and whether inhibition of interactions of HMGB1 and associated molecules with the cell surface can affect outcome after trauma. (Source: Critical Care)

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Open the doors of the ICU to patients with malignancies and neurological complications

Intensive Care Medicine — Wed, 11 Nov 2009 19:19:21 +0100

Content Type Journal ArticleCategory EditorialDOI 10.1007/s00134-009-1713-zAuthors Michael Piagnerelli, Erasme University Hospital, Université Libre de Bruxelles Department of Intensive Care 808, route de Lennik 1070 Brussels BelgiumBenjamin Legros, Erasme University Hospital, Université Libre de Bruxelles Department of Neurology 808, route de Lennik 1070 Brussels Belgium Journal Intensive Care MedicineOnline ISSN 1432-1238Print ISSN 0342-4642 (Source: Intensive Care Medicine)

Central neurological complications in critically ill patients with malignancies

Intensive Care Medicine — Wed, 11 Nov 2009 19:19:20 +0100

Conclusion In cancer patients, central neurological events are mainly related to malignant brain infiltration and drug-related toxicity. Despite advanced severity, a standardized intensive management strategy yields a 55% hospital survival rate. Content Type Journal ArticleCategory OriginalDOI 10.1007/s00134-009-1709-8Authors Stéphane Legriel, Hôpital Saint-Louis Medical Intensive Care Unit, AP-HP 75010 Paris FranceHélène Marijon, Hôpital Saint-Louis Medical Intensive Care Unit, AP-HP 75010 Paris FranceMichael Darmon, Hôpital Saint-Louis Medical Intensive Care Unit, AP-HP 75010 Paris FranceVirginie Lemiale, Hôpital Saint-Louis Medical Intensive Care Unit, AP-HP 75010 Paris FranceJean-Pierre Bedos, Hôpital Saint-Louis Medical Intensive Care Unit, AP-HP 75010 Par...

A Proposed Algorithm for Initiation of Renal Replacement Therapy in Adult Critically Ill Patients

Critical Care — Wed, 11 Nov 2009 00:00:00 +0100

The objective of this algorithm is to provide a starting point to guide clinicians on when to initiate RRT in critically ill adult patients. In addition, the proposed algorithm is intended to provide a foundation for prospective evaluation and the development of a broad consensus on when to initiate RRT in critically ill patients. (Source: Critical Care)

Transpulmonary thermodilution-derived cardiac function index identifies cardiac dysfunction in acute heart failure and septic patients: an observational study

Critical Care — Wed, 11 Nov 2009 00:00:00 +0100

Whereas the pulmonary artery catheter (PAC) is still widely used in guiding assessment and treatment of heart failure, controversy surrounding its safety and efficacy has prompted development of newer less invasive techniques. For these purposes, the transpulmonary thermodilution technique (TPT) allows assessment of preload, cardiac output, filling volumes, and metrics of contractility without the need to pass a catheter through the right heart. But these metrics remain relatively untested in heart failure. In this issue of Critical Care, Ritter and colleagues compare metrics of TPT to the PAC in patients with acute heart failure (AHF) and severe sepsis. Patients with AHF had a lower cardiac index, a lower left ventricular stroke work index and a higher pulmonary artery occlusion pressure ...

Primary graft dysfunction: it's all the RAGE.

Am J Respir Crit Car... — Tue, 10 Nov 2009 15:06:25 +0100

Authors: Wilkes DS PMID: 19897768 [PubMed - in process] (Source: Am J Respir Crit Car...)

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Searching for the tuberculosis "needle in the haystack": do we need a new approach to find tuberculosis in countries with a low burden of tuberculosis?

Am J Respir Crit Car... — Tue, 10 Nov 2009 15:06:23 +0100

Authors: Migliori GB, Weis S PMID: 19897769 [PubMed - in process] (Source: Am J Respir Crit Car...)

Approaches to achieving universal health care in the United States: where should the American thoracic society stand?

Am J Respir Crit Car... — Tue, 10 Nov 2009 15:06:20 +0100

Authors: Brown LK, Marcy TW, Kissner D, Douglas I, PMID: 19897770 [PubMed - in process] (Source: Am J Respir Crit Car...)

Pro: single-payer health care: simple, fair, and affordable.

Am J Respir Crit Car... — Tue, 10 Nov 2009 15:06:18 +0100

Authors: Day JA PMID: 19897771 [PubMed - in process] (Source: Am J Respir Crit Car...)

Con: single-payer health care: why it's not the best answer.

Am J Respir Crit Car... — Tue, 10 Nov 2009 15:06:15 +0100

Authors: Diamond MA PMID: 19897772 [PubMed - in process] (Source: Am J Respir Crit Car...)

Combined effects of obesity and chronic obstructive pulmonary disease on dyspnea and exercise tolerance.

Am J Respir Crit Car... — Tue, 10 Nov 2009 15:06:13 +0100

CONCLUSIONS: The combined mechanical effects of obesity and COPD reduced operating lung volumes at rest and throughout exercise with favorable influences on dyspnea perception and peak oxygen uptake during cycle ergometry. PMID: 19897773 [PubMed - in process] (Source: Am J Respir Crit Car...)

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An official American thoracic society statement: position statement on ATS activities for the promotion of respiratory and sleep/wake health and the care of the critically ill in the United States.

Am J Respir Crit Car... — Tue, 10 Nov 2009 15:06:10 +0100

CONCLUSIONS: The American Thoracic Society's Mission, Core Principles, and Vision provide clear guidance for the formulation of specific strategies that will serve to promote improved respiratory health and care of the critically ill in the United States. PMID: 19897774 [PubMed - in process] (Source: Am J Respir Crit Car...)

Rapid DNA methylation changes after exposure to traffic particles: the issue of spatio-temporal factors.

Am J Respir Crit Car... — Tue, 10 Nov 2009 15:06:08 +0100

Authors: Patel MM, Miller RL PMID: 19897775 [PubMed - in process] (Source: Am J Respir Crit Car...)

Simvastatin as a potential therapeutic for acute respiratory distress syndrome.

Am J Respir Crit Car... — Tue, 10 Nov 2009 15:06:05 +0100

Authors: Fessler MB PMID: 19897776 [PubMed - in process] (Source: Am J Respir Crit Car...)

Obstetric intensive care unit admission: a 2-year nationwide population-based cohort study

Intensive Care Medicine — Mon, 09 Nov 2009 19:11:25 +0100

Conclusions Population-based incidence of obstetric ICU admission in the Netherlands was 2.4 per 1,000 deliveries. Obstetric ICU admission accounts for only one-third of all cases of severe maternal morbidity in the Netherlands. Content Type Journal ArticleCategory OriginalDOI 10.1007/s00134-009-1707-xAuthors Joost J. Zwart, Leiden University Medical Centre Department of Obstetrics, K6-P-35 P.O. Box 9600 2300 RC Leiden The NetherlandsJust R. O. Dupuis, Leiden University Medical Centre Department of Obstetrics, K6-P-35 P.O. Box 9600 2300 RC Leiden The NetherlandsAnnemiek Richters, Leiden University Medical Centre Department of Public Health and Primary Care Leiden The NetherlandsFerko Öry, TNO Prevention and Health Department of Public Health Leiden The NetherlandsJos ...

Does PELOD measure organ dysfunction…and is organ function a valid surrogate for death?

Intensive Care Medicine — Mon, 09 Nov 2009 19:11:25 +0100

Content Type Journal ArticleCategory EditorialDOI 10.1007/s00134-009-1712-0Authors Shane M. Tibby, Guy’s and St Thomas’ NHS Foundation Trust Paediatric Intensive Care Unit, Evelina Children’s Hospital Westminster Bridge Road London SE1 7EH UK Journal Intensive Care MedicineOnline ISSN 1432-1238Print ISSN 0342-4642 (Source: Intensive Care Medicine)

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Abnormal Sleep and Errors More Common in ICU Nurses

Medscape Critical Care Headlines — Mon, 09 Nov 2009 17:18:21 +0100

Intensive care unit (ICU) nurses are more likely than floor nurses to have abnormal sleep and to experience a drop in vigilance during their shift that could impair patient safety, according to study findings presented this week at the CHEST 2009 meeting in San Diego, California. Reuters Health Information (Source: Medscape Critical Care Headlines)

Weakness in the ICU: A call to action

Critical Care — Mon, 09 Nov 2009 00:00:00 +0100

Muscle weakness is prevalent in critically ill patients and can have a dramatic effect on short and long term outcomes, yet there are currently no interventions with proven efficacy in preventing or treating this complication. In a new randomized trial, researchers found that serial electrical muscle stimulation significantly mitigated ultrasound-defined muscle atrophy, and the treatment was not linked to adverse effects. Although preliminary, these results, together with other recent studies, indicate a paradigm shift to a more proactive approach in managing neuromuscular complications in the ICU. (Source: Critical Care)

Semi-recumbent position and body mass percentiles: effects on intra-abdominal pressure measurements in critically ill children

Intensive Care Medicine — Fri, 06 Nov 2009 18:53:37 +0100

Conclusion Patient position should be considered when interpreting IAP. BMI did not influence IAP measurements in children. Content Type Journal ArticleCategory Pediatric OriginalDOI 10.1007/s00134-009-1708-9Authors Janeth Chiaka Ejike, Loma Linda University Department of Pediatrics, School of Medicine 11175 Campus Street, Suite A1117 Loma Linda CA 92354 USAJose Kadry, Loma Linda University School of Nursing, Children’s Hospital Loma Linda USAKhaled Bahjri, Loma Linda University Department of Epidemiology and Biostatistics, School of Public Health Loma Linda CA USAMudit Mathur, Loma Linda University Department of Pediatrics, School of Medicine 11175 Campus Street, Suite A1117 Loma Linda CA 92354 USA Journal Intensive Care MedicineOnline ISSN 1432-1238Print ISSN...

Thrombotic thrombocytopenic purpura associated with pregnancy: case report

Revista Brasileira de Terapia Intensiva — Fri, 06 Nov 2009 15:36:37 +0100

A púrpura trombocitopênica trombótica (PTT) é uma entidade rara em pacientes críticos. Relatamos um caso clínico de paciente gestante admitida em unidade de terapia intensiva obstétrica com quadro de alteração de sensório, atribuído inicialmente à doença hipertensiva da gravidez. Evoluiu com piora do quadro geral caracterizada por anemia e plaquetopenia grave, suscitando a investigação diagnóstica de púrpura trombocitopênica trombótica após o reconhecimento do perfil hematológico. Os autores enfatizam a importância do conhecimento da doença como marcador de prognóstico para pacientes obstétricas, em vista da semelhança com outras patologias comuns ao ciclo gravídico-puerperal e o fato do diagnóstico e tratamento precoce serem determinantes para o desfecho.Case r...

Use of automated external defibrillator in Peruvian out-of-hospital environment: improving emergency response in Latin America

Revista Brasileira de Terapia Intensiva — Fri, 06 Nov 2009 15:36:37 +0100

Este relato de caso reporta o atendimento pré-hospitalar de um paciente com fatores de risco atendido pelo serviço pré-hospitalar ao ser acometido por uma parada cardíaca e apresentar fibrilação ventricular. O paciente foi atendido seguindo os padrões de suporte básico de vida e suporte cardiovascular avançado. Um desfibrilador automático externo (DAE) foi aplicado com resultados favoráveis e o paciente se recuperou do quadro de perigo de vida com sucesso. Este é o primeiro relato documentado com resultados favoráveis no Peru, na área de atendimento pré-hospitalar e enfatiza a necessidade de serem adotadas políticas de acesso público à desfibrilação precoce.This case report relates out-of-hospital care to a patient with risk factors treated in the out-of-hospital servic...

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Intestinal constipation in intensive care units

Revista Brasileira de Terapia Intensiva — Fri, 06 Nov 2009 15:36:37 +0100

A constipação intestinal é uma complicação comumente identificada entre pacientes graves. Sua incidência é bastante variável devido à carência de uma definição aplicável a estes pacientes. Além das consequências já conhecidas da constipação, nos últimos anos tem-se percebido que essa complicação também pode estar relacionada ao pior prognóstico de pacientes críticos. Ao longo desta revisão procurou-se descrever as principais evidências científicas disponíveis mostrando ser a constipação um marcador prognóstico e uma das representações clínicas da disfunção intestinal, além da possibilidade de interferir no prognóstico com o tratamento. Revisou-se também a síndrome de Ogilvie, importante causa de morbidade e mortalidade nas unidades de terapia intensi...

Red blood cell transfusion in the intensive care setting: controversies amongst evidence

Revista Brasileira de Terapia Intensiva — Fri, 06 Nov 2009 15:36:37 +0100

A anemia é um problema prevalente nas unidades de terapia intensiva. Ela surge nos primeiros dias e pode sustentar-se, ou agravar-se, durante a internação. A etiologia normalmente é multifatorial. A transfusão de hemácias é a intervenção mais comumente utilizada para combatê-la. Aproximadamente 12 milhões de unidades de sangue são utilizadas para transfusões nos Estados Unidos, sendo 25% a 30% dentro das terapias intensivas. A maior segurança com a diminuição das infecções provocadas por transfusões permitiu uma ampliação de indicações clínicas. No entanto, a terapia transfusional está associada a outros efeitos adversos, como infecções nosocomiais, comprometimento imunológico, injúria pulmonar, reações hemolíticas e aumento da incidência de câncer. Alguns...

Glucose control in critically ill patients in 2009: no alarms and no surprises

Revista Brasileira de Terapia Intensiva — Fri, 06 Nov 2009 15:36:37 +0100

Na última década o controle glicêmico em pacientes críticos foi alvo de grande polêmica. Apesar de ter sido amplamente implementado na prática médica, os grandes estudos randomizados controlados obtiveram resultados bastante conflitantes, pois além de controlar a hiperglicemia, foi identificada a necessidade de se evitar os riscos da hipoglicemia, evento potencialmente grave nessa população. Dessa forma, o presente artigo se propõe a rever e avaliar de forma crítica os estudos publicados sobre controle glicêmico em terapia intensiva, propondo um novo alvo glicêmico (150 mg / dl) que seja capaz de minimizar os malefícios da hiperglicemia e ao mesmo tempo minimizar os riscos potenciais do uso de insulina de forma intensiva.Glucose control is a major issue in critical care sinc...

1st Forum of the Southern Cone End-of-Life Study Group: proposal for care of patients, bearers of terminal disease staying in the ICU

Revista Brasileira de Terapia Intensiva — Fri, 06 Nov 2009 15:36:37 +0100

The objective of this comment is to suggest an algorithm for the care of terminally ill patients. It was formulated based upon literature and the experience of experts, by members of the ethics committee and end-of-life of AMIB - Brazilian Association of Intensive Care. (Source: Revista Brasileira de Terapia Intensiva)

Occupational stress and repercussions on the quality of life of pediatric and neonatal intensivist physicians and nurses

Revista Brasileira de Terapia Intensiva — Fri, 06 Nov 2009 15:36:37 +0100

OBJETIVO: Investigar as relações entre trabalho e qualidade de vida de médicos e enfermeiros em unidades de terapia intensiva pediátrica e neonatal. MÉTODOS: Estudo transversal com 37 médicos e 20 enfermeiros. O Job Content Questionnarie (JCQ), Effort-Reward Imbalance (ERI) e World Health Organization Quality of Life (WHOQOL-100) foram utilizados. A correlação foi estimada através do coeficiente de correlação de Spearman. RESULTADOS: O esforço é inversamente correlacionado com os domínios: físico, psicológico, nível de independência, meio ambiente (p

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Breathing pattern in weaning patients: comparison of two inspired oxygen fractions

Revista Brasileira de Terapia Intensiva — Fri, 06 Nov 2009 15:36:37 +0100

CONCLUSIONS: These results suggest that FiO2 levels sufficient to ensure a SpO2>92% did not alter breathing patterns or trigger clinical changes in weaning patients. (Source: Revista Brasileira de Terapia Intensiva)

Humanization of physiotherapy care: study with patients post-stay in the intensive care unit

Revista Brasileira de Terapia Intensiva — Fri, 06 Nov 2009 15:36:37 +0100

CONCLUSION: Physiotherapy care given in the intensive care unit was marked by good assistance, attention provided to the patient and quality of treatment, characterizing humanized care. (Source: Revista Brasileira de Terapia Intensiva)

Nursing care adverse events at an intensive care unit

Revista Brasileira de Terapia Intensiva — Fri, 06 Nov 2009 15:36:37 +0100

CONCLUSION: The occurrence of adverse events in the care given to patients by the nursing team are significant indicators that disclose the quality of nursing care. Therefore, these events should be analyzed to support in-service training of the nursing staff. (Source: Revista Brasileira de Terapia Intensiva)

Infections in patients submitted to hemodialysis: a systematic review

Revista Brasileira de Terapia Intensiva — Fri, 06 Nov 2009 15:36:37 +0100

CONCLUSION: There is a need for studies about infection incidence in critically ill, submitted to dialysis with temporary catheters, due to acute renal injury to define a causal relationship and risk factors to orient adequate prevention and control measures. (Source: Revista Brasileira de Terapia Intensiva)

Aged patients with respiratory dysfunction: epidemiological profile and mortality risk factors

Revista Brasileira de Terapia Intensiva — Fri, 06 Nov 2009 15:36:37 +0100

OBJETIVOS: Descrever população de pacientes idosos em relação a jovens em ventilação mecânica e analisar fatores de risco para mortalidade na unidade de terapia intensiva neste grupo. MÉTODOS: Estudo prospectivo observacional, em pacientes com idade acima de 18 anos, admitidos na unidade de terapia intensiva em ventilação mecânica no período de um ano. Os pacientes foram divididos em dois grupos de acordo com a idade: Grupo 1- pacientes acima de 65 anos e Grupo 2 com idade menor ou igual a 65 anos. RESULTADOS: Foram incluídos 81 pacientes, 62 idosos e 19 jovens em ventilação mecânica. A média de idade dos idosos foi 76 anos, enquanto o grupo mais jovem apresentou média de 56 anos. Idosos em comparação aos controles, apresentaram maiores tempo de ventilação mecânica, ...

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Prognostic factors in elderly patients admitted in the intensive care unit

Revista Brasileira de Terapia Intensiva — Fri, 06 Nov 2009 15:36:37 +0100

OBJETIVOS: Atualmente o envelhecimento populacional é proeminente fenômeno mundial. Então, a avaliação do prognóstico em pacientes idosos é necessária, sendo assim o objetivo deste estudo foi identificar fatores de risco em população de pacientes idosos admitidos em unidade de terapia intensiva. MÉTODOS: Foi realizado estudo prospectivo, em unidade de terapia intensiva geral de um hospital terciário, durante 5 meses. Pacientes com idade maior ou igual a 65 anos que permaneceram na unidade de terapia intensiva por tempo maior ou igual a 24 horas foram incluídos, pacientes moribundos e aqueles readmitidos na unidade de terapia intensiva durante mesma internação hospitalar foram excluídos. RESULTADOS: Foram envolvidos no estudo 199 pacientes com média de idade de 75,4± 6,8 a...

Individual prognostic assessment in the intensive care unit: can therapeutic persistence be distinguished from therapeutic obstinacy?

Revista Brasileira de Terapia Intensiva — Fri, 06 Nov 2009 15:36:37 +0100

CONCLUSION: Assessment of individual evolutionary prognostic proved to be a useful method to objectively subsidize ethical decisions related to therapeutic persistence and therapeutic obstinacy. (Source: Revista Brasileira de Terapia Intensiva)

Pulmonary embolism: multicenter registry in tertiary hospitals

Revista Brasileira de Terapia Intensiva — Fri, 06 Nov 2009 15:36:37 +0100

CONCLUSIONS: It was observed that age>40 years, prolonged rest and neoplasms were the most prevalent risk factors and dyspnea and tachypnea were the more frequent clinical manifestations. Helical computer tomography was the most often used method to confirm diagnosis and non-fractioned heparin was the main form of treatment. (Source: Revista Brasileira de Terapia Intensiva)

Outcome of influenza A (H1N1) patients admitted to intensive care units in the Paraná state, Brazil

Revista Brasileira de Terapia Intensiva — Fri, 06 Nov 2009 15:36:37 +0100

CONCLUSIONS: Adult patients with A (H1N1) virus infection admitted to intensive care units had a high risk of death, particularly due to respiratory impairment. Positive RT-PCR, urea and lactic dehydrogenase, low initial PaO2/FiO2 and high levels of PEEP were correlated with higher mortality. (Source: Revista Brasileira de Terapia Intensiva)

Is the Way to Man's Heart (and Lung) Through the Abdomen?

Critical Care — Fri, 06 Nov 2009 00:00:00 +0100

Intra-abdominal hypertension (IAH) is increasingly recognized to be both prevalent and clinically important in medical and surgical ICUs. Intra-abdominal pressure (IAP) can impact organ function throughout the body, and it can also complicate standard measurements used in ICU care. The article by Krebs et al. reports the effect of IAP on respiratory function, gas exchange and hemodynamic function. Their results show a relatively small effect of modestly elevated IAP on these variables in their patient population. However, their work raises several questions for clinicians and researchers regarding the pathophysiology and management of IAP. (Source: Critical Care)

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Anaesthesia in septic patients: good preparation and making the right choice?

Critical Care — Fri, 06 Nov 2009 00:00:00 +0100

Septic patients may require anaesthesia for surgery or to facilitate endotracheal intubation for respiratory failure. These patients frequently start with a deranged haemodynamic state including vasodilation with hypotension, and cardiomyopathy, making induction of anaesthesia a potentially hazardous task. Anaesthetic agents are well known to decrease contractility and cause vasodilation, in part from direct effect of the drugs, and in part due to the "state of anaesthesia" which causes reduced sympathetic tone. Before induction, the physician should understand the haemodynamic state (especially using echocardiography), restore cardiovascular reserve with inotropes and vasopressors, and induce anaesthesia with the smallest dose of the safest drug. In this issue of Critical Care, Zausig and...

Multidisciplinary care for tracheostomy patients: a systematic review

Critical Care — Fri, 06 Nov 2009 00:00:00 +0100

Conclusions: In the papers we appraised, patients with a tracheostomy tube in situ discharged from an ICU to a general ward who received care from a dedicated multidisciplinary team as compared with standard care showed reductions in time to decannulation, length of stay and adverse events. Impacts on quality of care were not reported. These results should be interpreted with caution due to the methodological weaknesses in the historical control studies. (Source: Critical Care)

U.S. Patients More Likely to Spend Their Last Days in the ICU

SCCM RSS News — Thu, 05 Nov 2009 21:56:53 +0100

Dying hospital patients in the United States are nearly five times more likely to spend their last days in the intensive care unit (ICU) than patients in England. In addition, U.S. patients older than age 85 are eight times more likely to be in the ICU when they die. This according to a study published in the American Journal of Respiratory and Critical Care Medicine from Columbia University researchers who compared data from England and from seven U.S. states: Florida, Massachusetts, New Jersey, New York, Texas, Virginia and Washington... (Source: SCCM RSS News)

Be the First Know When Online Journal Content Is Available

SCCM RSS News — Thu, 05 Nov 2009 21:56:10 +0100

Be one of the first to know what is being published in your field and in your journal! Select from two options to keep abreast of the latest research... (Source: SCCM RSS News)

Are You Involved in SCCM's Specialty Sections?

SCCM RSS News — Thu, 05 Nov 2009 21:55:44 +0100

All members of the Society of Critical Care Medicine (SCCM) are eligible to join up to three sections at no cost (Pediatrics Section members pay nominal dues to cover the cost of a Pediatric Critical Care Medicine journal subscription). The Society offers 15 sections, each catering to the needs of the critical care professional regardless of their role in the multiprofessional team... (Source: SCCM RSS News)

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Vote for the 2010 SCCM Council

SCCM RSS News — Thu, 05 Nov 2009 21:55:17 +0100

All Society of Critical Care Medicine (SCCM) members may vote online in this year’s Council election. In addition, Fellows of the American College of Critical Care Medicine are invited to vote for members of the Board of Regents in conjunction with the Society’s Council elections... (Source: SCCM RSS News)

Discounted Hotel Accommodations for Congress Are Going Fast

SCCM RSS News — Thu, 05 Nov 2009 21:54:52 +0100

Make your travel arrangements now for the 39th Critical Care Congress, as hotel rooms are filling up fast. Housing reservations must be made by December 4, 2009, but do not delay. Reserve your room online today, or visit the SCCM Web site for details about these choice hotels... (Source: SCCM RSS News)

Have You Visited LearnICU Lately

SCCM RSS News — Thu, 05 Nov 2009 21:54:26 +0100

LearnICU offers a plethora of open-access resources of interest to each member of the multiprofessional critical care team. Guidelines, webcasts (some offering CE credit), select book chapters and journal articles, and much more are available at no cost. Recent additions include the video presentations Recombinant Factor VIIa Therapy in Acute Hemorrhage and Are Your Everyday Drugs Killing Patients?... (Source: SCCM RSS News)

Discover the Latest H1N1 News and Resources

SCCM RSS News — Thu, 05 Nov 2009 21:54:05 +0100

The Society of Critical Care Medicine (SCCM) has been awarded a contract from the Department of Health and Human Services to develop an online course aimed at educating multiprofessional, multidisciplinary non-critical care professionals on preparing for and responding to the anticipated surge in critically ill patients with influenza during the upcoming months. Critical Care Cross-Training of Hospital-Based, Non-ICU Healthcare Professionals will cover core elements of critical care support, include pediatric-specific critical care considerations, and provide guidance on how to operate mechanical ventilators from the U.S. Strategic National Stockpile. Details coming soon... (Source: SCCM RSS News)

Promising iNO Therapy Results in Infants Not Sustained

SCCM RSS News — Thu, 05 Nov 2009 21:53:46 +0100

Inhaled nitric oxide (iNO), a therapy used in the treatment of premature newborns with respiratory failure that had shown promising results in short-term studies, does not improve long-term outcomes significantly, according to a national study led by researchers at the University of Pittsburgh School of Medicine and Children's Hospital of Pittsburgh in Pennsylvania... (Source: SCCM RSS News)

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NIH Embarks on Social Networking Site for Researchers

SCCM RSS News — Thu, 05 Nov 2009 21:53:26 +0100

Inability to identify and access research resources is a major obstacle to the advancement of science and medicine. In an effort to overcome such obstacles and harness the power of social networking, the National Institutes of Health (NIH) has awarded two universities grants totaling $27 million to develop a national online infrastructure for researchers... (Source: SCCM RSS News)

A retrospective analysis on the impact of caloric intake on glycemic control in critically ill patients

Intensive Care Medicine — Thu, 05 Nov 2009 19:04:23 +0100

Content Type Journal ArticleCategory CorrespondenceDOI 10.1007/s00134-009-1679-xAuthors Yuen Ting Lau, Detroit Receiving Hospital Department of Pharmacy Services 4201 St. Antoine Blvd Detroit MI 48201 USALance J. Oyen, Hospital Pharmacy Services, Mayo Clinic-Rochester 200 First St. S.W. Rochester MN 55905 USAMichael Malinchoc, Mayo Clinic-Rochester Department of Biostatistics 200 First St. S.W. Rochester MN 55905 USAChristopher J. Arendt, Hospital Pharmacy Services, Mayo Clinic-Rochester 200 First St. S.W. Rochester MN 55905 USAMelissa M. Barth, Mayo Clinic-Rochester Department of Nursing 1216 Second Street SW Rochester MN 55902 USA Journal Intensive Care MedicineOnline ISSN 1432-1238Print ISSN 0342-4642 (Source: Intensive Care Medicine)

Am J Respir Crit Care Med; +24 new citations

Am J Respir Crit Car... — Thu, 05 Nov 2009 01:36:02 +0100

24 new pubmed citations were retrieved for your search. Click on the search hyperlink below to display the complete search results: Am J Respir Crit Care Med These pubmed results were generated on 2009/11/04PubMed, a service of the National Library of Medicine, includes over 15 million citations for biomedical articles back to the 1950's. These citations are from MEDLINE and additional life science journals. PubMed includes links to many sites providing full text articles and other related resources. (Source: Am J Respir Crit Car...)

The impact of crystalloid and colloid infusion on the kidney in rodent sepsis

Intensive Care Medicine — Wed, 04 Nov 2009 21:59:36 +0100

Conclusion None of the examined volume solution was inert to the kidney. In a CLP rodent sepsis model, animals infused with balanced crystalloid SteroIso exhibited the least effects on kidney function. Both hydroxyethyl starch 6% 130/0.4 and gelatin 4% derogated the kidney, whereas gelatin was more harmful when compared with hydroxyethyl starch. Content Type Journal ArticleCategory ExperimentalDOI 10.1007/s00134-009-1704-0Authors Martin Alexander Schick, University of Würzburg Klinik und Poliklinik für Anästhesiologie, Zentrum für Operative Medizin Oberdürrbacherstrasse 6 97080 Würzburg GermanyTobias Jobst Isbary, University of Würzburg Klinik und Poliklinik für Anästhesiologie, Zentrum für Operative Medizin Oberdürrbacherstrasse 6 97080 Würzburg GermanyNi...

Neue Rubrik: Berufspolitisches Forum

Intensivmedizin und Notfallmedizin — Wed, 04 Nov 2009 06:58:12 +0100

Content Type Journal ArticleCategory In eigener SacheDOI 10.1007/s00390-009-0123-3Authors L. Engelmann, Universitätsklinikum Leipzig AöR Einheit für Multidisziplinäre Intensivmedizin (EMI) Liebigstr. 20 04103 Leipzig Deutschland Journal Intensivmedizin und NotfallmedizinOnline ISSN 1435-1420Print ISSN 0175-3851 (Source: Intensivmedizin und Notfallmedizin)

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Department of Health publishes new guide to improve neonatal care

NeLM - Intensive Care (ICU) — Wed, 04 Nov 2009 00:00:00 +0100

Source: Department of Health (DH) Area: News The Department of Health has published new guidance to help the NHS improve the care provided for premature and sick babies during their first days. The new guidance has been based on findings identified by the Neonatal Taskforce, and experts from the baby charity Bliss and specialist NHS staff have helped to develop the Neonatal Toolkit. The Toolkit provides practical advice on how to improve areas that really matter to parents including (taken directly from source): . making sure the right staff are on hand at the birth . managing high-risk pregnancies to make sure babies are born in the best place . improving transfers between services where necessary The Toolkit includes a set of eight principles for qua...

Early release of high mobility group box nuclear protein 1 after severe trauma in humans: role of injury severity and tissue hypoperfusion

Critical Care — Wed, 04 Nov 2009 00:00:00 +0100

Conclusions: The results of this study demonstrate for the first time that HMGB1 is released into the bloodstream early after severe trauma in humans. The release of HMGB1 requires severe injury and tissue hypoperfusion, and is associated with posttraumatic coagulation abnormalities, activation of complement and severe systemic inflammatory response. (Source: Critical Care)

Risk factors for acute respiratory distress syndrome during neutropenia recovery in patients with hematologic malignancies

Critical Care — Tue, 03 Nov 2009 00:00:00 +0100

Conclusions: Patients with hematologic malignancies complicated by pneumonia during neutropenia are at increased risk for ARDS during neutropenia recovery. (Source: Critical Care)

Decrease of CD4 lymphocytes and apoptosis of CD14 monocytes are characteristic alterations in sepsis caused by ventilator-associated pneumonia: results from an observational study

Critical Care — Mon, 02 Nov 2009 00:00:00 +0100

Conclusions: Decrease of CD4-lymphocytes and immunoparalysis of monocytes are characteristic alterations of sepsis arising in the field of VAP. (Source: Critical Care)

[Suicide and suicidality in emergency medicine]

Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS — Sun, 01 Nov 2009 00:00:00 +0100

This article aims to give an overview of prevalence rates, method of suicide or attempted suicide, and the problems faced by EPs when treating these patients. In addition, concepts are presented which allow for an adequate risk assessment of suicidality and showing possibilities of primary crisis intervention. PMID: 19918703 [PubMed - in process] (Source: Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS)

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[Difficult airway management in paediatric patients]

Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS — Sun, 01 Nov 2009 00:00:00 +0100

Authors: Laschat M, Kaufmann J, Wappler F A difficult airway in childhood is very uncommon. Therefore, it will always be an unfamiliar and menacing situation for most anaesthetists. Knowledge of the individual pathology, associated anaesthesiological problems and possible solutions provide the basis for successful airway management. Endoscopical techniques are essential for the process. The following article shows how a difficult airway in childhood can be recognized and which anaesthesiological options exist to handle such a situation. PMID: 19918704 [PubMed - in process] (Source: Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS)

[Co-analgesics--today and tomorrow--a receptor-based overview of therapeutical options]

Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS — Sun, 01 Nov 2009 00:00:00 +0100

We describe the peripheral action sites of co-analgesics, such as cannabinoids, capsaicin, bisphosphonates, steroids and somatostatin. We also summarise the effect of peripherally and centrally acting ion-channel blockers, e.g. local anaesthetics, carbamazepine and tolperisone working on sodium channels and gabapentin and pregabalin working on calcium channels. Finally, central analgesic mechanisms are discussed, for instance the inhibition of NMDA-receptors by ketamine or magnesium, the stimulation of alpha2-receptors by clonidine, tizanidine or antidepressants, the activation of GABA-receptors through baclofen and other analgesic mechanisms of i.e. ondansetron and neostigmine. PMID: 19918705 [PubMed - in process] (Source: Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerzthera...

[In Process Citation]

Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS — Sun, 01 Nov 2009 00:00:00 +0100

Authors: Roewer N, Kranke P PMID: 19918706 [PubMed - in process] (Source: Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS)

[Perioperative management of patients with neuromuscular disorders]

Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS — Sun, 01 Nov 2009 00:00:00 +0100

This article reviews the anaesthetic approach with regard to preoperative considerations and perioperative management in this heterogeneous group of patients. PMID: 19918707 [PubMed - in process] (Source: Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS)

[Malignant hyperthermia--diagnostics, treatment and anaesthetic management]

Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS — Sun, 01 Nov 2009 00:00:00 +0100

This article reviews the clinical symptoms of MH, the diagnostic criteria and the actual guidelines for treatment and management of anaesthesia in susceptible individuals. PMID: 19918708 [PubMed - in process] (Source: Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS)

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[In Process Citation]

Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS — Sun, 01 Nov 2009 00:00:00 +0100

Authors: Papenfuss T, Roch C, Schwemmer U Neuromuscular disorders are rare and often not very well diagnosed diseases. They can be separated in prejunctional, junctional or postjunctional diseases. General anesthesia is connected with a higher risk, therefore regional anesthesia could often be regarded with favour and could be a safe alternative. Because of the lack of systematically studies and guidelines the decision choosing a regional anesthesia is always a risk-benefit-analysis. This and also the detailed preoperative neurological status must, because of forensic reason, exactly be documented. PMID: 19918709 [PubMed - in process] (Source: Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS)

[A German network for regional anaesthesia of the scientific working group regional anaesthesia within DGAI and BDA]

Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS — Sun, 01 Nov 2009 00:00:00 +0100

Authors: Volk T, Engelhardt L, Spies C, Steinfeldt T, Kutter B, Heller A, Werner C, Heid F, Bürkle H, Koch T, Vicent O, Geiger P, Kessler P, Wulf H Regional anaesthesia generally is considered to be safe. However, reports of complications with different severities are also well known. The scientific working group of regional anaesthesia of the DGAI has founded a network in conjunction with the BDA. With the aid of a registry, we are now able to describe risk profiles and associations in case of a complication. Moreover, a benchmark has been implemented in order to continuously improve complication rates. PMID: 19918710 [PubMed - in process] (Source: Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS)

Organ dysfunction is associated with hyperglycemia in critically ill children

Intensive Care Medicine — Sat, 31 Oct 2009 12:57:36 +0100

Conclusions Organ dysfunction (≥3 versus <3) was significantly associated with hyperglycemia for ≥24 h and hypoglycemia. Hyperglycemia trended toward significance with mortality in critically ill children. There was no association between hypoglycemia and mortality. Content Type Journal ArticleCategory OriginalDOI 10.1007/s00134-009-1703-1Authors Ursula G. Kyle, Baylor College of Medicine Pediatric Critical Care Medicine, Texas Children’s Hospital 6621 Fannin, WT6-006 Houston Texas 77030 USAJorge A. Coss Bu, Baylor College of Medicine Pediatric Critical Care Medicine, Texas Children’s Hospital 6621 Fannin, WT6-006 Houston Texas 77030 USACurtis E. Kennedy, Baylor College of Medicine Pediatric Critical Care Medicine, Texas Children’s Hospital 6621 Fanni...

Ultrasound-guided arterial catheterization: a narrative review

Intensive Care Medicine — Sat, 31 Oct 2009 12:57:34 +0100

Abstract Arterial catheterization is the second most common invasive procedure performed in the intensive care unit. Despite the ubiquity of the procedure, complications including failure to place the catheter occur. While many clinicians are familiar with the use of ultrasound (US) guidance to decrease complication rates of central venous catheter insertion, fewer are familiar with the use of ultrasound to guide arterial catheterization. This manuscript reviews the evidence for the utility of ultrasound for this indication. Technical aspects of the procedure and limitations of the existing evidence are reviewed. A description of the procedure is provided, along with an online supplemental video. Most studies indicate that first-pass success will be improved with US-guided...

Diagnose und kausale Therapie der Sepsis

Intensivmedizin und Notfallmedizin — Fri, 30 Oct 2009 18:29:56 +0100

Zusammenfassung Trotz einer Vielzahl verbesserter supportiver und adjunktiver Therapiemaßnahmen hat sich an der hohen Letalität und Morbidität, die der schweren Sepsis und dem septischen Schock geschuldet sind, innerhalb der letzten 20 Jahre wenig geändert. Grund hierfür sind v. a. Defizite in der frühzeitigen Diagnose, der – wann immer möglichen – chirurgischen Herdsanierung und/oder der antibiotischen Therapie des Infektionsfokus. Einer weltweit steigenden Resistenzentwicklung der wichtigsten Infektionserreger gegenüber allen gängigen Antibiotika einerseits steht andererseits keine vergleichbare Entwicklung neuer antiinfektiver Substanzen gegenüber. Vor allem im Bereich gramnegativer Probleminfektionen mit Non-Fermentern wie Pseudomonas aeruginosa ...

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Kortikosteroide bei schwerer Sepsis und septischem Schock

Intensivmedizin und Notfallmedizin — Fri, 30 Oct 2009 18:29:55 +0100

Zusammenfassung Der Nutzen einer adjunktiven Therapie mit niedrig dosierten Kortikosteroiden bei Patienten mit schwerer Sepsis und septischem Schock wird kontrovers diskutiert. Diese Übersicht informiert über wichtige Funktionen des zentralen Stresshormons Kortisol und stellt das Konzept der relativen Nebennierenrindeninsuffizienz im septischen Schock dem der Kortikosteroidinsuffizienz bei schweren systemischen Inflammationen gegenüber. Es wird die aktuelle Datenlage unter Einbeziehung von neuesten Metaanalysen kritisch evaluiert; hierbei wird auch auf mögliche Nebenwirkungen dieser Therapie eingegangen. Es folgen abschließend evidenzbasierte Therapieempfehlungen für die Applikation von niedrig dosiertem Hydrokortison bei Patienten mit schwerem septischem Schock. C...

Akutes Nierenversagen bei Sepsis

Intensivmedizin und Notfallmedizin — Fri, 30 Oct 2009 18:29:52 +0100

Zusammenfassung Das akute Nierenversagen stellt ein für die Prognose des septischen Patienten entscheidendes Organversagen dar. Neue Vorstellungen in der Pathophysiologie sowie klarere neue Definitionen sollen in der Zukunft zu besseren Behandlungsoptionen führen. Derzeit sind das frühzeitige Erkennen, die rasche zielgerichtete Kreislauftherapie mit kristalloiden Lösungen und Vasopressoren sowie das Vermeiden nephrotoxischer Substanzen die wichtigsten Bausteine der Prävention und Therapie. Ist eine Nierenersatztherapie notwendig, sollte diese frühzeitig nach Intensivaufnahme begonnen werden. Unterschiedliche Verfahren mit verschiedenen Vor- und Nachteilen stehen zur Verfügung, die im Sinne einer Differenzialtherapie eingesetzt werden sollten. Eine ausreichende Dosis...

Editorial

Intensivmedizin und Notfallmedizin — Fri, 30 Oct 2009 18:29:51 +0100

Content Type Journal ArticleCategory EditorialDOI 10.1007/s00390-009-0093-5Authors H.-P. Schuster, Klinikum Hildesheim, Lehrkrankenhaus der MHH Medizinische Klinik I Weinberg 1 31134 Hildesheim Deutschland Journal Intensivmedizin und NotfallmedizinOnline ISSN 1435-1420Print ISSN 0175-3851 (Source: Intensivmedizin und Notfallmedizin)

SCCM Pod-118 PCCM: HLH and Sepsis

SCCM PodCast - iCritical Care — Fri, 30 Oct 2009 09:44:00 +0100

Leticia Castillo, MD, FCCM, assistant professor at Baylor College of Medicine in Houston, Texas, discusses an article published in Pediatric Critical Care Medicine. (Source: SCCM PodCast - iCritical Care)

Volume responsiveness in ICU patients: who is fluid responsive?

Critical Care — Fri, 30 Oct 2009 00:00:00 +0100

No Abstract. (Source: Critical Care)

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Sepsis

Intensivmedizin und Notfallmedizin — Thu, 29 Oct 2009 19:44:20 +0100

Content Type Journal ArticleCategory EditorialDOI 10.1007/s00390-009-0129-xAuthors F.M. Brunkhorst, Universitätsklinikum Jena Paul-Martini-Forschergruppe für Klinische Sepsisforschung Erlanger Allee 101 07737 Jena Deutschland Journal Intensivmedizin und NotfallmedizinOnline ISSN 1435-1420Print ISSN 0175-3851 (Source: Intensivmedizin und Notfallmedizin)

Ernährung und metabolische Kontrolle bei Sepsis

Intensivmedizin und Notfallmedizin — Thu, 29 Oct 2009 19:44:19 +0100

Zusammenfassung Ernährungstherapie bei Intensivpatienten kann mehr sein als nur die Zufuhr von Kalorien. Septische Patienten können einen Vorteil von früher enteraler Ernährung haben. In großen multizentrischen Studien wurde das Konzept der metabolischen Kontrolle auch bei septischen Patienten untersucht, allerdings war eine intensivierte Insulintherapie mit einem Blutzuckerziel von 80–110 mg/dl nicht erfolgreich. Die Ernährung mit einer enteralen Immunonutrition, die bei postoperativen Patienten zu einer Verminderung der Liegezeiten führte, kann bei Patienten mit schwerer Sepsis zu einer Erhöhung der Mortalität führen. Für die parenterale Ernährung sollten neuere Lipidemulsionen genutzt werden, die wahrscheinlich Vorteile für den septischen Patienten br...

Lung Pathology in Fatal Novel Human Influenza A (H1N1) Infection.

Am J Respir Crit Car... — Thu, 29 Oct 2009 00:00:00 +0100

CONCLUSIONS: Autopsies have shown that the main pathological changes associated with S-OIV infection are localized to the lungs, where three distinct histological patterns can be identified. We also show evidence of ongoing pulmonary aberrant immune response. Our results reinforce the utility of autopsy in increasing the understanding of the novel human influenza A (H1N1) infection. PMID: 19875682 [PubMed - as supplied by publisher] (Source: Am J Respir Crit Car...)

Pulmonary Hypertension and CT Measurement of Small Pulmonary Vessels in Severe Emphysema.

Am J Respir Crit Car... — Thu, 29 Oct 2009 00:00:00 +0100

CONCLUSIONS: The %CSA<5 measured on CT images is significantly correlated to Ppa in severe emphysema, and can estimate the degree of pulmonary hypertension. PMID: 19875683 [PubMed - as supplied by publisher] (Source: Am J Respir Crit Car...)

Hemodynamic and Gas Exchange Effects of Sildenafil in Patients with COPD and Pulmonary Hypertension.

Am J Respir Crit Car... — Thu, 29 Oct 2009 00:00:00 +0100

CONCLUSION: In patients with COPD-associated PH, sildenafil improves pulmonary hemodynamics at rest and during exercise. This effect is accompanied by the inhibition of hypoxic vasoconstriction, which impairs arterial oxygenation at rest. The use of sildenafil in COPD should be done cautiously and under close monitoring of blood gases. PMID: 19875684 [PubMed - as supplied by publisher] (Source: Am J Respir Crit Car...)

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Antibiotics in Addition to Systemic Corticosteroids for Acute Exacerbations of COPD.

Am J Respir Crit Car... — Thu, 29 Oct 2009 00:00:00 +0100

CONCLUSIONS: While equivalent to placebo on clinical success at day 30, doxycycline showed superiority on clinical success and clinical cure at day 10, microbiological success, the use of open label antibiotics and symptoms. (ClinicalTrials.gov #NCT00170222.). PMID: 19875685 [PubMed - as supplied by publisher] (Source: Am J Respir Crit Car...)

Resuscitation Promoting Factors Reveal an Occult Population of Tubercle Bacilli in Sputum.

Am J Respir Crit Car... — Thu, 29 Oct 2009 00:00:00 +0100

CONCLUSIONS: Smear-positive sputum samples are dominated by a population of Mtb cells that can only be grown in the presence of Rpfs. These intriguing proteins are therefore relevant to human infection. The Rpf-dependent population is invisible to conventional culture and is progressively enhanced in relative terms during chemotherapy, indicating a form of phenotypic resistance that may be significant for both chemotherapy and transmission. PMID: 19875686 [PubMed - as supplied by publisher] (Source: Am J Respir Crit Car...)

Reduction of Tumstatin in Asthmatic Airways Contributes to Angiogenesis, Inflammation and Hyperresponsiveness.

Am J Respir Crit Car... — Thu, 29 Oct 2009 00:00:00 +0100

CONCLUSIONS: The observation that tumstatin is decreased in asthmatic airways and inhibits airway hyperresponsiveness and angiogenesis demonstrates the potential use of anti-angiogenic agents such as tumstatin as a therapeutic intervention in diseases which are characterized by aberrant angiogenesis and tissue remodeling, such as asthma. PMID: 19875687 [PubMed - as supplied by publisher] (Source: Am J Respir Crit Car...)

Dual Inhibition of Cathepsin G and Chymase is Effective in Animal Models of Pulmonary Inflammation.

Am J Respir Crit Car... — Thu, 29 Oct 2009 00:00:00 +0100

CONCLUSIONS: The preclinical anti-inflammatory effects of RWJ-355871 in these animal models of inflammation indicate that this dual inhibitor may have therapeutic utility for treating airway inflammatory diseases involving mechanisms that depend on cathepsin G and/or chymase. PMID: 19875688 [PubMed - as supplied by publisher] (Source: Am J Respir Crit Car...)

Recovery of Multipotent Progenitors from the Peripheral Blood of Patients Requiring ECMO Support.

Am J Respir Crit Car... — Thu, 29 Oct 2009 00:00:00 +0100

CONCLUSIONS: Hematopoietic, mesenchymal and epithelial progenitors were mobilized into the circulation of patients on ECMO. This may reflect a response to severe cardiopulmonary injury, blood-foreign surface interactions with the ECMO circuit and/or hemodilution. PMID: 19875689 [PubMed - as supplied by publisher] (Source: Am J Respir Crit Car...)

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Selected Medical Errors in the ICU: Results of the IATROREF Study (Parts I and II).

Am J Respir Crit Car... — Thu, 29 Oct 2009 00:00:00 +0100

Conclusions. The impact of medical errors on mortality indicates an urgent need for developing prevention programs. We have planned a study to assess a program based on our results. PMID: 19875690 [PubMed - as supplied by publisher] (Source: Am J Respir Crit Car...)

Changes in serum creatinine in the first 24 hours after cardiac arrest indicate prognosis: an observational cohort study

Critical Care — Thu, 29 Oct 2009 00:00:00 +0100

Conclusions: In this large cohort of patient after cardiac arrest, we found that AKI occurs in nearly 50% of patients when the new criteria are applied. Patients with unfavourable neurological outcome are affected more frequently. A significant association between the development of AKI and NSE levels indicating hypoxic brain damage was observed. Our data show that changes in serum creatinine may contribute to the prediction of outcome in patients with cardiac arrest. Whereas a decline in serum creatinine (> 0.2 mg/dL) in the first 24 hours after cardiac arrest indicates good prognosis, the risk of unfavourable outcome is markedly elevated in patients with constant or increasing serum creatinine. (Source: Critical Care)

A retrospective cohort pilot study to evaluate a triage tool for use in a pandemic

Critical Care — Thu, 29 Oct 2009 00:00:00 +0100

Conclusions: Refinement of the triage protocol and implementation is required prior to future study, including improved training of triage officers, and protocol modification to minimize the exclusion from critical care of patients who may in fact benefit. However, our results suggest that the triage protocol can help to direct resources to patients who are most likely to benefit, and help to decrease the demands on critical care resources, thereby making available more resources to treat other critically ill patients. (Source: Critical Care)

Epidemiology and Outcome of Nosocomial Bloodstream Infection in Elderly Critically Ill Patients: A Comparison Between Middle-Aged, Old, And Very Old Patients

Medscape Critical Care Headlines — Wed, 28 Oct 2009 14:33:24 +0100

Investigators evaluated the epidemiology of nosocomial bloodstream infection in elderly intensive care unit (ICU) patients. Critical Care Medicine (Source: Medscape Critical Care Headlines)

Swine flu - Provision of ventilation in a "worst case scenario"

Critical Care — Wed, 28 Oct 2009 00:00:00 +0100

Editor,As a busy intensive care unit at a district general hospital in the UK, we are intrigued by the "worst case scenario" plans for swine flu in our region and the ubiquitous algorithms that form part of this planning.A Department of Health document suggests for the purposes of planning that, during a first major UK pandemic wave, the peak clinical attack rate per week would be 8% [1]. Of these patients, hospitalization rate would be 2% and of these 25% would require intensive care "if the capacity exists"Our hospital serves a population of 220,000. In our region, these estimates suggest that 352 patients will require hospital admission each week during the peak. Using these calculations, we could expect 88 patients per week to require ICU support.In this hospital, there is the capacity...

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Recently Published Papers : Novel therapies in COPD, Cardiac chemicals & Intensive Care Outcomes

Critical Care — Tue, 27 Oct 2009 00:00:00 +0100

The burden of chronic obstructive pulmonary disease (COPD) on intensive care is heavy, but newer modalities of treatment are now available to improve outcomes. Cardiac based research continues to generate new drugs and tests to better outcome and aid in early diagnosis. And how do various intensive care interventions compare in improving clnical & functional outcomes? (Source: Critical Care)

Goal directed therapy in high risk surgical patients

Critical Care — Mon, 26 Oct 2009 00:00:00 +0100

A small group of patients account for most of the operative morbidity and mortality. These "high-risk" patients do badly as they are unable to meet the oxygen transport demands imposed on them by the nature of the surgical response during the peri operative period. It has been shown that by targeting specific haemodynamic and oxygen transport goals at any point during the peri operative period their outcomes can be improved. This goal directed therapy includes the use of fluid loading and inotropes, originally with the aid of the pulmonary artery catheter but more recently with less invasive flow monitoring devices. Despite the benefits seen, it remains a challenge to implement this management due to difficulties in identifying all of these patients, scepticism and lack of critical care r...

Mortality in very long-stay pediatric intensive care unit patients and incidence of withdrawal of treatment

Intensive Care Medicine — Fri, 23 Oct 2009 18:52:27 +0100

Conclusions Children with prolonged stay in the PICU have a significantly high risk of mortality. Death is typically preceded by limitation of care. Content Type Journal ArticleCategory Pediatric OriginalDOI 10.1007/s00134-009-1693-zAuthors Sara Naghib, Erasmus Medical Centre, Sophia Children’s Hospital Department of Intensive Care P.O. Box 2060 3000 CB Rotterdam The NetherlandsCynthia van der Starre, Erasmus Medical Centre, Sophia Children’s Hospital Department of Intensive Care P.O. Box 2060 3000 CB Rotterdam The NetherlandsSaskia J. Gischler, Erasmus Medical Centre, Sophia Children’s Hospital Department of Intensive Care P.O. Box 2060 3000 CB Rotterdam The NetherlandsKoen F. M. Joosten, Erasmus Medical Centre, Sophia Children’s Hospital Department of Intensi...

Elevated PAI-1 is associated with poor clinical outcomes in pediatric patients with acute lung injury

Intensive Care Medicine — Fri, 23 Oct 2009 18:52:27 +0100

Conclusions Higher PAI-1 levels are associated with increased mortality and fewer ventilator-free days among pediatric patients with ALI. These findings suggest that impaired fibrinolysis may play a role in the pathogenesis of ALI in pediatric patients and suggest that PAI-1 may serve as a useful biomarker of prognosis in patients with ALI. Content Type Journal ArticleCategory ExperimentalDOI 10.1007/s00134-009-1690-2Authors Anil Sapru, University of California, San Francisco Division of Critical Care Medicine, Department of Pediatrics Box 0106 San Francisco CA 94143 USAMartha A. Q. Curley, University of Pennsylvania School of Nursing Philadelphia PA USASandra Brady, University of California, San Francisco Cardiovascular Research Institute San Francisco CA USAMichael ...

Reply to Dubin

Intensive Care Medicine — Fri, 23 Oct 2009 18:52:26 +0100

Content Type Journal ArticleCategory CorrespondenceDOI 10.1007/s00134-009-1682-2Authors Marcio Manozzo Boniatti, Hospital de Clínicas de Porto Alegre-Critical Care Ramiro Barcellos Porto Alegre 90670090 BrazilPaulo Ricardo Cerveira Cardoso, Hospital de Clínicas de Porto Alegre-Critical Care Ramiro Barcellos Porto Alegre 90670090 BrazilRodrigo Kappel Castilho, Hospital de Clínicas de Porto Alegre-Critical Care Ramiro Barcellos Porto Alegre 90670090 BrazilSilvia Regina Rios Vieira, Hospital de Clínicas de Porto Alegre-Critical Care Ramiro Barcellos Porto Alegre 90670090 Brazil Journal Intensive Care MedicineOnline ISSN 1432-1238Print ISSN 0342-4642 (Source: Intensive Care Medicine)

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Improving acid–base evaluation: the proper use of the old tools

Intensive Care Medicine — Fri, 23 Oct 2009 18:52:26 +0100

Content Type Journal ArticleCategory CorrespondenceDOI 10.1007/s00134-009-1680-4Authors Arnaldo Dubin, Universidad Nacional de La Plata Cátedra de Farmacología Aplicada, Facultad de Ciencias Médicas Calle 42 no. 577 La Plata Buenos Aires 1900 ArgentinaFabio D. Masevicius, Sanatorio Otamendi y Miroli Servicio de Terapia Intensiva Buenos Aires Argentina Journal Intensive Care MedicineOnline ISSN 1432-1238Print ISSN 0342-4642 (Source: Intensive Care Medicine)

beta-Adrenergic modulation in sepsis

Critical Care — Thu, 22 Oct 2009 23:00:00 +0100

Sepsis, despite recent therapeutic progress, still carries unacceptably high mortality rates. The adrenergic system, a key modulator of organ function and cardiovascular homeostasis, could be an interesting new therapeutic target for septic shock. β-Adrenergic regulation of the immune function in sepsis is complex and is time dependent. However, β2 activation as well as β1 blockade seems to downregulate proinflammatory response by modulating the cytokine production profile. β1 blockade improves cardiovascular homeostasis in septic animals, by lowering myocardial oxygen consumption without altering organ perfusion, and perhaps by restoring normal cardiovascular variability. β-Blockers could also be of interest in the systemic catabolic response to sepsis, as they oppose epinephrine whi...

Dilutional acidosis or uncovered cellular metabolism?

Intensive Care Medicine — Thu, 22 Oct 2009 18:55:11 +0100

Content Type Journal ArticleCategory EditorialDOI 10.1007/s00134-009-1700-4Authors Andrew Davenport, University College London Medical School Center for Nephrology Royal Free Campus, Rowland Hill Street London NW3 2PF UK Journal Intensive Care MedicineOnline ISSN 1432-1238Print ISSN 0342-4642 (Source: Intensive Care Medicine)

Understanding the Sequence of Pulmonary Injury in the Extremely Low Birth Weight, Surfactant-Deficient Infant

Medscape Critical Care Headlines — Thu, 22 Oct 2009 14:39:16 +0100

This article provides bedside clinicians with foundational information about the sequence of events that can ultimately lead to neonatal chronic lung disease and bronchopulmonary dysplasia. Neonatal Network (Source: Medscape Critical Care Headlines)

{beta}2-Adrenergic Receptor Gene Polymorphism is Associated with Mortality in Septic Shock.

Am J Respir Crit Car... — Wed, 21 Oct 2009 23:00:00 +0100

CONCLUSION: The AA genotype of ADRB2 rs1042717, identifying homozygotes for the CysGlyGln haplotype, was associated with increased mortality and more organ dysfunction in septic shock. PMID: 19850944 [PubMed - as supplied by publisher] (Source: Am J Respir Crit Car...)

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In utero Smoke Exposure and Maternal and Infant GST Genes on Airway Responsiveness and Lung Function In Infancy.

Am J Respir Crit Car... — Wed, 21 Oct 2009 23:00:00 +0100

CONCLUSIONS: GST genes may be especially important during fetal development as they may modify, through proficient detoxification, the effects of in utero maternal smoke exposure on AR in infants. PMID: 19850945 [PubMed - as supplied by publisher] (Source: Am J Respir Crit Car...)

Role of Epidermal Growth Factor Inhibition in Experimental Pulmonary Hypertension.

Am J Respir Crit Car... — Wed, 21 Oct 2009 23:00:00 +0100

CONCLUSION: The partial therapeutic efficacy of the EGFR antagonists in animal models of pulmonary hypertension and the absence of significant alteration in EGFR expression in the lungs from IPAH patients suggest that the EGFR do not represent a promising target for the treatment of pulmonary hypertension. PMID: 19850946 [PubMed - as supplied by publisher] (Source: Am J Respir Crit Car...)

Targeted Injury of Type II Alveolar Epithelial Cells Induces Pulmonary Fibrosis.

Am J Respir Crit Car... — Wed, 21 Oct 2009 23:00:00 +0100

CONCLUSIONS: The development of lung fibrosis in the setting of type II cell injury in our model provides evidence for a causal link between the epithelial defects seen in IPF and the corresponding areas of scarring. PMID: 19850947 [PubMed - as supplied by publisher] (Source: Am J Respir Crit Car...)

The influence of the airway driving pressure on pulsed pressure variation as a predictor of fluid responsiveness

Intensive Care Medicine — Wed, 21 Oct 2009 19:32:01 +0100

Conclusion In patients mechanically ventilated with low VT, PPV values <13% do not rule out fluid responsiveness, especially when (Pplat − PEEP) is ≤20 cmH2O. Content Type Journal ArticleCategory OriginalDOI 10.1007/s00134-009-1686-yAuthors Laurent Muller, Groupe Hospitalo-Universitaire Caremeau, CHU Nîmes Division Anesthésie Réanimation Douleur Urgences Place du Professeur Robert Debré 30029 Nîmes Cedex 9 FranceGuillaume Louart, Groupe Hospitalo-Universitaire Caremeau, CHU Nîmes Division Anesthésie Réanimation Douleur Urgences Place du Professeur Robert Debré 30029 Nîmes Cedex 9 FrancePhilippe-Jean Bousquet, Université Montpellier 1 Faculté de Médecine Montpellier FranceDamien Candela, Groupe Hospitalo-Universitaire Caremeau, CHU Nîm...

The bispectral index and suppression ratio are very early predictors of neurological outcome during therapeutic hypothermia after cardiac arrest

Intensive Care Medicine — Wed, 21 Oct 2009 19:31:59 +0100

Conclusions In our single-center cohort utilizing moderate sedation, the bispectral index and suppression ratio recorded after the first dose of intermittent neuromuscular blockade were accurate and very early predictors of neurological outcome during therapeutic hypothermia after cardiac arrest. Content Type Journal ArticleCategory OriginalDOI 10.1007/s00134-009-1691-1Authors David B. Seder, Maine Medical Center Neuroscience Institute 22 Bramhall St Portland ME 04102 USAGilles L. Fraser, Maine Medical Center Neuroscience Institute 22 Bramhall St Portland ME 04102 USATracy Robbins, Maine Medical Center Neuroscience Institute 22 Bramhall St Portland ME 04102 USALaurel Libby, Maine Medical Center Neuroscience Institute 22 Bramhall St Portland ME 04102 USARichard R. Rike...

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Moderate hypothermia with intracranial pressure monitoring as a therapeutic paradigm for the management of acute liver failure: a systematic review

Intensive Care Medicine — Wed, 21 Oct 2009 19:31:58 +0100

Conclusions Limited data exist concerning the safety and efficacy of moderate hypothermia and ICP monitoring for the treatment of ICH in acute liver failure. The available evidence shows that induction of moderate hypothermia in this clinical setting is feasible and possibly efficacious. Well-designed prospective clinical trials are warranted in this challenging context, given the potential of providing a bridge to liver transplantation or even clinical recovery. Content Type Journal ArticleCategory ReviewDOI 10.1007/s00134-009-1702-2Authors Dayton Dmello, Saint Louis University School of Medicine Division of Pulmonary, Critical Care and Sleep Medicine 1402 South Grand Blvd, 7 Desloge Towers St Louis MO 63104 USASalvador Cruz-Flores, Saint Louis University School of ...

F-18-fluorodeoxyglucose positron emission tomography combined with CT in critically ill patients with suspected infection

Intensive Care Medicine — Wed, 21 Oct 2009 19:31:58 +0100

Conclusions FDG-PET/CT scanning is of additional value in the evaluation of suspected infection in critically ill patients in whom conventional diagnostics did not lead to a diagnosis. Apart from the high accuracy, in this study it appeared that, in addition to conventional diagnostic techniques that were routinely performed, a normal FDG-PET/CT ruled out important infections requiring prolonged antibiotic therapy or drainage. Since sensitivity is lower in highly metabolic active tissues (e.g., endocarditis, meningitis), the FDG-PET/CT scan is not suited to detect infections in these tissues. Content Type Journal ArticleCategory OriginalDOI 10.1007/s00134-009-1697-8Authors Koen S. Simons, Radboud University Nijmegen Medical Centre Department of Intensive Care Medici...

Incidence and prognosis of dysnatremias present on ICU admission

Intensive Care Medicine — Wed, 21 Oct 2009 19:31:58 +0100

Conclusions Our results suggest that both hypo- and hypernatremia present on admission to the ICU are independent risk factors for poor prognosis. Content Type Journal ArticleCategory OriginalDOI 10.1007/s00134-009-1692-0Authors Georg-Christian Funk, Otto Wagner Spital Department of Respiratory and Critical Care Medicine Vienna AustriaGregor Lindner, Medical University of Vienna Department of Anesthesiology and General Intensive Care Medicine Währingergürtel 18-20 1090 Vienna AustriaWilfred Druml, Medical University of Vienna Department of Nephrology and Dialysis Vienna AustriaBarbara Metnitz, Medical University of Vienna Department of Medical Statistics Vienna AustriaChristoph Schwarz, Krankenhaus der Elisabethinen Third Medical Department Linz AustriaPeter Bauer, M...

Discharge Teaching in the NICU: Are Parents Prepared? An Integrative Review of Parents' Perceptions

Medscape Critical Care Headlines — Wed, 21 Oct 2009 16:00:00 +0100

At the end of their infant's NICU stay, parents are expected to assume full responsibility for their infant's care. Do parents feel that discharge practices prepare them effectively? Neonatal Network (Source: Medscape Critical Care Headlines)

Blunting the response to endotoxin in healthy subjects: effects of various doses of intravenous fish oil

Intensive Care Medicine — Wed, 21 Oct 2009 09:04:29 +0100

Conclusions Having previously shown that the response to LPS was reproducible, this study shows that three FO doses blunted it to various degrees. The 0.2 g/kg perfusion immediately before LPS was the most efficient in blunting the responses, suggesting LPS capture in addition to the systemic and membrane effects. Content Type Journal ArticleCategory OriginalDOI 10.1007/s00134-009-1689-8Authors Yann K. Pittet, CHUV Service of Adult Intensive Care Medicine and Burns Centre 1011 Lausanne SwitzerlandMette M. Berger, CHUV Service of Adult Intensive Care Medicine and Burns Centre 1011 Lausanne SwitzerlandThomas-Thi Pluess, CHUV Service of Adult Intensive Care Medicine and Burns Centre 1011 Lausanne SwitzerlandPierre Voirol, CHUV Pharmacy Lausanne SwitzerlandJean-Pierr...

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Acute gastrointestinal bleeding due to oesophageal varices: an unusual case of a thoracic spleen

Intensive Care Medicine — Wed, 21 Oct 2009 09:04:29 +0100

Content Type Journal ArticleCategory CorrespondenceDOI 10.1007/s00134-009-1696-9Authors Gerrit C. Hagenah, Georg-August University of Goettingen Medical School Department of Nephrology and Rheumatology Robert-Koch Str. 40 37075 Göttingen GermanyJens-Gerd Scharf, Georg-August University of Goettingen Medical School Department of Gastroenterology and Endocrinology Göttingen GermanyAlexander Emmert, Georg-August University of Goettingen Medical School Department of Thoracic and Cardiovascular Surgery Göttingen GermanyB. Michael Ghadimi, Georg-August University of Goettingen Medical School Department of General Surgery Göttingen GermanyFriedrich A. Schöndube, Georg-August University of Goettingen Medical School Department of Thoracic and Cardiovascular Surgery Göttingen GermanyBernha...

Value of procalcitonin for diagnosis of early onset pneumonia in hypothermia-treated cardiac arrest patients

Intensive Care Medicine — Wed, 21 Oct 2009 09:04:28 +0100

Conclusions The diagnostic value of PCT is poor after cardiac arrest and should not be performed to assess early onset pneumonia. The post-resuscitation disease itself could play a major role in this lack of specificity and predictive value. Content Type Journal ArticleCategory OriginalDOI 10.1007/s00134-009-1681-3Authors Nicolas Mongardon, Cochin Hospital, AP-HP Medical Intensive Care Unit 27 rue du Faubourg Saint-Jacques 75679 Paris Cedex 14 FranceVirginie Lemiale, Cochin Hospital, AP-HP Medical Intensive Care Unit 27 rue du Faubourg Saint-Jacques 75679 Paris Cedex 14 FranceSébastien Perbet, Cochin Hospital, AP-HP Medical Intensive Care Unit 27 rue du Faubourg Saint-Jacques 75679 Paris Cedex 14 FranceFlorence Dumas, Hôtel Dieu Hospital, AP-HP Emergency Department 1...

Early physiological and biological features in three animal models of induced acute lung injury

Intensive Care Medicine — Wed, 21 Oct 2009 04:05:35 +0100

Conclusions The early responses to direct or remote lung insult in our three models of ALI captured different physiological and biological features that could lead to respiratory and/or multiorgan failure. Content Type Journal ArticleCategory ExperimentalDOI 10.1007/s00134-009-1695-xAuthors Josefina López-Aguilar, Corporació Parc Taulí, Institut Universitari, Esfera UAB Critical Care Center, Hospital de Sabadell Parc Taulí s/n 08208 Sabadell SpainMaría Elisa Quilez, Corporació Parc Taulí, Institut Universitari, Esfera UAB Critical Care Center, Hospital de Sabadell Parc Taulí s/n 08208 Sabadell SpainOctavi Martí-Sistac, Corporació Parc Taulí, Institut Universitari, Esfera UAB Critical Care Center, Hospital de Sabadell Parc Taulí s/n 08208 Sabadell SpainCarol...

Coming soon to an ICU near you: Severe Pandemic Influenza in ICU Patients in Spain

Critical Care — Tue, 20 Oct 2009 23:00:00 +0100

A novel strain of swine influenza A H1N1 has already disseminated worldwide and has become a major clinical problem for intensive care units in selected areas. Many regions in the Southern Hemisphere are currently struggling to keep up with the influx of severely affected patients with acute respiratory failure from primary influenza pneumonia. The Northern hemisphere is bracing for a similar surge of patients over the next winter's influenza season. This initial report of ventilatory needs for patients with severe influenza pneumonia in Spanish ICUs provides a useful guide of what to expect, and how to respond to the challenge of pandemic influenza. (Source: Critical Care)

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