2012 Oct - Clinical and Biologic Features of Patients Suspected or Confirmed to Have Heparin-Induced Thrombocytopenia in a Cardiothoracic Surgical ICU
Background: The diagnosis of heparin-induced thrombocytopenia (HIT) is problematic in the surgical ICU, as there are multiple potential explanations for thrombocytopenia. We conducted a study to assess the incidence, clinical presentation, and outcome of HIT in a cardiothoracic surgical ICU.
Background: Patient safety remains a national priority, but the role of disease-specific characteristics in safety is not well characterized.
Background: Vasopressin is known to be an effective vasopressor in the treatment of septic shock, but uncertainty remains about its effect on other hemodynamic parameters.
Background: No data on long-term outcomes of survivors of 2009 influenza A(H1N1) (A[H1N1])-associated ARDS are available. The objective of this study was to compare the 1-year outcomes of survivors of A(H1N1)-associated ARDS, according to use or no use of extracorporeal lung assist (ECLA), using its need as an ARDS severity surrogate.
Background: Different kinds of ventilators are available to perform noninvasive ventilation (NIV) in ICUs. Which type allows the best patient-ventilator synchrony is unknown. The objective was to compare patient-ventilator synchrony during NIV between ICU, transport—both with and without the NIV algorithm engaged—and dedicated NIV ventilators.
2012 Jul - Technologic Advances in Endotracheal Tubes for Prevention of Ventilator-Associated Pneumonia
Ventilator-associated pneumonia (VAP) is associated with high morbidity, mortality, and costs. Interventions to prevent VAP are a high priority in the care of critically ill patients requiring mechanical ventilation (MV). Multiple interventions are recommended by evidence-based practice guidelines to prevent VAP, but there is a growing interest in those related to the endotracheal tube (ETT) as the main target linked to VAP.
2012 Jul - Comparison and Agreement Between the Richmond Agitation-Sedation Scale and the Riker Sedation-Agitation Scale in Evaluating Patients’ Eligibility for Delirium Assessment in the ICU
Background: Delirium evaluation in patients in the ICU requires the use of an arousal/sedation assessment tool prior to assessing consciousness. The Richmond Agitation-Sedation Scale (RASS) and the Riker Sedation-Agitation Scale (SAS) are well-validated arousal/sedation tools. We sought to assess the concordance of RASS and SAS assessments in determining eligibility of patients in the ICU for delirium screening using the confusion assessment method for the ICU (CAM-ICU).
Background: A recent ICU telemedicine research consensus conference identified the need for reliable methods of measuring structural features and processes of critical care delivery in the domains of organizational context and characteristics of ICU teams, ICUs, hospitals, and of the communities supported by an ICU.
2012 Jul - Subtherapeutic Initial β-Lactam Concentrations in Select Critically Ill Patients: Association Between Augmented Renal Clearance and Low Trough Drug Concentrations
Background: β-Lactams are routinely used as empirical therapy in critical illness, with extended concentrations above the minimum inhibitory concentration (MIC) of the infecting organism required for effective treatment. Changes in renal function in this setting can significantly impact the probability of achieving such targets.
2012 Jun - In Vivo Platelet Activation in Critically Ill Patients With Primary 2009 Influenza A(H1N1)
Background: Changes in platelet reactivity during 2009 influenza A(H1N1) (A[H1N1]) have not been characterized.
2012 May - Diagnostic Accuracy of Ultrasonography in the Acute Assessment of Common Thoracic Lesions After Trauma
Background: The accuracy of combined clinical examination (CE) and chest radiography (CXR) (CE + CXR) vs thoracic ultrasonography in the acute assessment of pneumothorax, hemothorax, and lung contusion in chest trauma patients is unknown.
Background: Current rapid response team activation criteria were not statistically derived using ward vital signs, and the best vital sign predictors of cardiac arrest (CA) have not been determined. In addition, it is unknown when vital signs begin to accurately detect this event prior to CA.
2012 May - The Association Between a Darc Gene Polymorphism and Clinical Outcomes in African American Patients With Acute Lung Injury
Background: Acute lung injury (ALI) mortality is increased among African Americans compared with Americans of European descent, and genetic factors may be involved. A functional T-46C polymorphism (rs2814778) in the promoter region of Duffy antigen/receptor for chemokines (Darc) gene, present almost exclusively in people of African descent, results in isolated erythrocyte DARC deficiency and has been implicated in ALI pathogenesis in preclinical and murine models, possibly because of an increase in circulating Duffy-binding, proinflammatory chemokines like IL-8. We sought to determine the effect of the functional rs2814778 polymorphism, C/C genotype (Duffy null state), on clinical outcomes in African Americans with acute lung injury.
Background: Animal models suggest that immunomodulatory properties of macrolide antibiotics have therapeutic value for patients with acute lung injury (ALI). We investigated the association between receipt of macrolide antibiotics and clinical outcomes in patients with ALI.
Pneumothorax in critically ill patients remains a common problem in the ICU, occurring in 4% to 15% of patients. Pneumothorax should be considered a medical emergency and requires a high index of suspicion, prompt recognition, and intervention.
2012 Apr - 24/7 In-house Intensivist Coverage and Fellowship Education A Cross-sectional Survey of Academic Medical Centers in the United States
Objectives: The objectives of this study were to determine the current staffing models of practice and the frequency of 24/7 coverage in academic medical centers in the United States and to assess the perceptions of critical care trainees and program directors toward these models.
2012 Mar - Surveillance Tracheal Aspirate Cultures Do Not Reliably Predict Bacteria Cultured at the Time of an Acute Respiratory Infection in Children With Tracheostomy Tubes
Background: The aim of this study was to characterize the practice of routinely obtaining tracheal aspirate cultures in children with tracheostomy tubes and to analyze the appropriateness of using this information to guide antibiotic selection for treatment of subsequent lower respiratory infections.
2012 Feb - Severity Scoring in the Critically Ill Part 2: Maximizing Value From Outcome Prediction Scoring Systems
Part 2 of this review of ICU scoring systems examines how scoring system data should be used to assess ICU performance. There often are two different consumers of these data: lCU clinicians and quality leaders who seek to identify opportunities to improve quality of care and operational efficiency, and regulators, payors, and consumers who want to compare performance across facilities.
2012 Jan - Decision Support Tool for Early Differential Diagnosis of Acute Lung Injury and Cardiogenic Pulmonary Edema in Medical Critically Ill Patients
Christopher N. Schmickl, Khurram Shahjehan, MD, Guangxi Li, MD, Rajanigandha Dhokarh, MD, Rahul Kashyap, MD, Christopher Janish, Anas Alsara, MD, Allan S. Jaffe, MD, Rolf D. Hubmayr, MD and Ognjen Gajic, MD. Published online before print October 26, 2011, doi: 10.1378/chest.11-1496 CHEST January 2012 vol. 141 no. 1 43-50
Background: At the onset of acute hypoxic respiratory failure, critically ill patients with acute lung injury (ALI) may be difficult to distinguish from those with cardiogenic pulmonary edema (CPE). No single clinical parameter provides satisfying prediction. We hypothesized that a combination of those will facilitate early differential diagnosis.
2011 Dec - The Timing of Tracheotomy in Critically Ill Patients Undergoing Mechanical Ventilation: A Systematic Review and Meta-analysis of Randomized Controlled Trials
Background: The objective of this study was to systematically review and quantitatively synthesize all randomized controlled trials (RCTs), comparing important outcomes in ventilated critically ill patients who received an early or late tracheotomy.