2013 Mar - Physician Staffing Models Impact the Timing of Decisions to Limit Life Support in the ICU
Abstract
Background: A growing trend is the implementation of 24-h attending physician coverage in the ICU. Our aim was to measure the impact of 24-h, in-house, attending intensivist coverage on the quality of end-of-life care and the timing of end-of-life decision-making.
2013 Mar - Impact of the Administration of Probiotics on Mortality in Critically Ill Adult Patients: A Meta-analysis of Randomized Controlled Trials
Abstract
Background: The objective of this study was to systematically review and quantitatively synthesize all randomized controlled trials (RCTs) that have compared important outcomes in critically ill patients who received an administration of probiotics.
2013 Feb - Using Thoracic Ultrasonography to Accurately Assess Pneumothorax Progression During Positive Pressure Ventilation: A Comparison With CT Scanning
Abstract
Background: Although thoracic ultrasonography accurately determines the size and extent of occult pneumothoraces (PTXs) in spontaneously breathing patients, there is uncertainty about patients receiving positive pressure ventilation. We compared the lung point (ie, the area where the collapsed lung still adheres to the inside of the chest wall) using the two modalities ultrasonography and CT scanning to determine whether ultrasonography can be used reliably to assess PTX progression in a positive-pressure-ventilated porcine model.
2013 Feb - Tripeptide feG Prevents and Ameliorates Acute Pancreatitis-Associated Acute Lung Injury in a Rodent Model
Abstract
Background: The synthetic tripeptide feG (D-Phe-D-Glu-Gly) is a novel pharmacologic agent that decreases neutrophil recruitment, infiltration, and activation in various animal models of inflammatory disease. We aimed to investigate the effect of feG as both a preventive treatment when administered before acute lung injury and as a therapeutic treatment administered following initiation of acute lung injury.
2013 Feb - The Use of Bioreactance and Carotid Doppler to Determine Volume Responsiveness and Blood Flow Redistribution Following Passive Leg Raising in Hemodynamically Unstable Patients
Abstract
Background: The clinical assessment of intravascular volume status and volume responsiveness is one of the most difficult tasks in critical care medicine. Furthermore, accumulating evidence suggests that both inadequate and overzealous fluid resuscitation are associated with poor outcomes. The objective of this study was to determine the predictive value of passive leg raising (PLR)-induced changes in stroke volume index (SVI) as assessed by bioreactance in predicting volume responsiveness in a heterogenous group of patients in the ICU. A secondary end point was to evaluate the change in carotid Doppler flow following the PLR maneuver.
2013 Feb - Perception by Family Members and ICU Staff of the Quality of Dying and Death in the ICU: A Prospective Multicenter Study in The Netherlands
Abstract
Objective: Admission to the ICU is a major event in a patient’s life and also for family members. We tried to elucidate how family members and ICU caregivers experience the dying process of their patients.
2013 Jan - Neurally Adjusted Ventilatory Assist vs Pressure Support Ventilation for Noninvasive Ventilation During Acute Respiratory Failure: A Crossover Physiologic Study
Abstract
Background: Patient-ventilator asynchrony is common during noninvasive ventilation (NIV) with pressure support ventilation (PSV). We examined the effect of neurally adjusted ventilatory assist (NAVA) delivered through a facemask on synchronization in patients with acute respiratory failure (ARF).
2013 Jan - The Costs of Critical Care Telemedicine Programs: A Systematic Review and Analysis
Abstract
Background: Implementation of telemedicine programs in ICUs (tele-ICUs) may improve patient outcomes, but the costs of these programs are unknown. We performed a systematic literature review to summarize existing data on the costs of tele-ICUs and collected detailed data on the costs of implementing a tele-ICU in a network of Veterans Health Administration (VHA) hospitals.
2012 Dec - Diaphragm Muscle Thinning in Patients Who Are Mechanically Ventilated
Abstract
Background: Approximately 40% of patients in medical ICUs require mechanical ventilation (MV). Approximately 20% to 25% of these patients will encounter difficulties in discontinuing MV. Multiple studies have suggested that MV has an unloading effect on the respiratory muscles that leads to diaphragmatic atrophy and dysfunction, a process called ventilator-induced diaphragmatic dysfunction (VIDD).
2012 Dec - Proadrenomedullin Improves Risk of Early Admission to ICU Score for Predicting Early Severe Community-Acquired Pneumonia
Abstract
Background: Whether proadrenomedullin (ProADM) improves the performance of the Risk of Early Admission to ICU (REA-ICU) score in predicting early, severe community-acquired pneumonia (ESCAP) has not been demonstrated.
2012 Dec - Learned Helplessness Among Families and Surrogate Decision-Makers of Patients Admitted to Medical, Surgical, and Trauma ICUs
Abstract
Background: We sought to determine the prevalence of and clinical variables associated with learned helplessness, a psychologic state characterized by reduced motivation, difficulty in determining causality, and depression, in family members of patients admitted to ICUs.
2012 Dec - Real-time Perspectives of Surrogate Decision-Makers Regarding Critical Illness Research: Findings of Focus Group Participants
Abstract
Objective: We undertook the current investigation to explore how the pressures of serving as a surrogate decision-maker (SDM) for an acutely ill family member influence attitudes regarding clinical investigation.
2012 Dec - Ventilator-Associated Pneumonia Is Characterized by Excessive Release of Neutrophil Proteases in the Lung
Abstract
Background: Ventilator-associated pneumonia (VAP) is characterized by neutrophils infiltrating the alveolar space. VAP is associated with high mortality, and accurate diagnosis remains difficult. We hypothesized that proteolytic enzymes from neutrophils would be significantly increased and locally produced inhibitors of human neutrophil elastase (HNE) would be decreased in BAL fluid (BALF) from patients with confirmed VAP. We postulated that in suspected VAP, neutrophil proteases in BALF may help identify “true” VAP.
2012 Nov - Pseudomonas aeruginosa-Catecholamine Inotrope Interactions: A Contributory Factor in the Development of Ventilator-Associated Pneumonia?
Abstract
Background: Ventilated patients receiving intensive care are at significant risk of acquiring a ventilator-associated pneumonia that is associated with significant morbidity and mortality. Despite intensive research, it is still unclear why Pseudomonas aeruginosa, a microbe that rarely causes pneumonia outside of intensive care, is responsible for so many of these infections.
2012 Nov - Hypocapnia and Hypercapnia Are Predictors for ICU Admission and Mortality in Hospitalized Patients With Community-Acquired Pneumonia
Abstract
Objective: The purpose of our study was to examine in patients hospitalized with community-acquired pneumonia (CAP) the association between abnormal Paco2 and ICU admission and 30-day mortality.
2012 Nov - Identifying Elements of ICU Care That Families Report as Important But Unsatisfactory: Decision-Making, Control, and ICU Atmosphere
Abstract
Background: One in five deaths in the United States occurs in the ICU, and many of these deaths are experienced as less than optimal by families of dying people. The current study investigated the relationship between family satisfaction with ICU care and overall ratings of the quality of dying as a means of identifying targets for improving end-of-life experiences for patients and families.
2012 Nov - Does Admission During Morning Rounds Increase the Mortality of Patients in the Medical ICU?
Abstract
Background: Early optimization of treatment is crucial when admitting patients to the ICU and could depend on the organization of the medical team. The aim of this retrospective observational study was to determine whether admissions during morning rounds are independently associated with hospital mortality in a medical ICU.
2012 Oct - Lack of Efficacy of Probiotics in Preventing Ventilator-Associated Pneumonia: A Systematic Review and Meta-analysis of Randomized Controlled Trials
Abstract
Background: Ventilator-associated pneumonia (VAP) remains a common hazardous complication in patients who are mechanically ventilated and is associated with increased morbidity and mortality. We undertook a systematic review and meta-analysis of randomized controlled trials to evaluate the efficacy and safety of probiotics for the prevention of VAP.
2012 Oct - Comparison of APACHE III, APACHE IV, SAPS 3, and MPM0III and Influence of Resuscitation Status on Model Performance
Abstract
Background: There are few comparisons among the most recent versions of the major adult ICU prognostic systems (APACHE [Acute Physiology and Chronic Health Evaluation] IV, Simplified Acute Physiology Score [SAPS] 3, Mortality Probability Model [MPM]0III). Only MPM0III includes resuscitation status as a predictor.
2012 Oct - Drug-Associated Acute Lung Injury: A Population-Based Cohort Study
Abstract
Background: A number of drugs have been reported as risk factors for acute lung injury (ALI) and ARDS. However, evidence is largely limited to case reports, and there is a paucity of data on the incidence and outcome of drug-associated ALI (DALI).