2009 Sep - Study of prone positioning to reduce ventilator-associated pneumonia in hypoxemic patients.
2009 Sep - Hypertonic saline in critical care: a review of the literature and guidelines for use in hypotensive states and raised intracranial pressure [Review]
2009 Sep - Brachial artery peak velocity variation to predict fluid responsiveness in mechanically ventilated patients
In recent years, the use of the consensus definitions of acute kidney injury (RIFLE and AKIN) in the literature has increased substantially. This indicates a highly encouraging acceptance by the medical community of a unifying definition for acute kidney injury. This is a very important and positive step in the right direction. There remains some variation in how the criteria are interpreted and used in the literature, including use/nonuse of urine output criteria, use of change in estimated glomerular filtration rate rather than change in creatinine, and choice of baseline creatinine. The present review is intended to aid the reader in critically appraising studies using these consensus definitions.
2009 Sep - Admission factors associated with hospital mortality in patients with haematological malignancy admitted to UK adult, general critical care units: a secondary analysis of the ICNARC Case Mix Programme Database
2009 Sep - Extracorporeal life support in severe drug intoxication: a retrospective cohort study of seventeen cases
2009 Prokinetic drugs for feed intolerance in critical illness: current and potential therapies [Review]
Deane AM, Fraser RJ, Chapman MJ.; Crit Care Resusc. 2009 Jun;11(2):132-43.
Studies consistently show that nasogastric nutrition delivers only about 60% of nutritional goals in critically ill patients. The predominant reason is abnormal gastric motility, leading to delayed gastric emptying, which is evident clinically as large gastric residual volumes. Delayed gastric emptying occurs in about 50%-60% of critically ill patients who are fed enterally and can result in malnutrition. Furthermore, delayed gastric emptying may increase the risk of aspiration of gastric contents. Recent research has improved our understanding of the complex abnormalities of gastric motor function that underlie delayed gastric emptying in the critically ill.
2009 Delivered dose of renal replacement therapy and mortality in critically ill patients with acute kidney injury
Critical Care 2009, 13:R57doi:10.1186/cc7784; Published: 15 April 2009
Optimal dialysis dose for the treatment of acute kidney injury (AKI) is controversial. We sought to evaluate the relationship between renal replacement therapy (RRT) dose and outcome.
We performed a prospective multicenter observational study in 30 intensive care units (ICUs) in 8 countries from June 2005 to December 2007. Delivered RRT dose was calculated in patients treated exclusively with either continuous (CRRT) or intermittent RRT (IRRT) during their ICU stay. Dose was categorized into more-intensive (CRRT [greater than or equal to] 35ml/kg/hr, IRRT [greater than or equal to] 6sessions/week) or less-intensive (CRRT < 35ml/kg/hr, IRRT < 6sessions/week). The main outcome measures were ICU mortality, ICU length of stay, and duration of mechanical ventilation.
Authors: Gavin M. Joynt, Thomas ST Li, Joey KM Wai, Florence HY Yap
Critical Care and Shock » August 2008, Volume 11, No. 3
The classical syndrome of fat embolism is characterized by the triad of respiratory failure, neurologic dysfunction and the presence of a petechial rash.
Background Despite practice guidelines promoting delirium assessment in intensive care, few data exist regarding current delirium assessment practices among nurses and how these practices compare with those for sedation assessment.
Objectives To identify current practices and perceptions of intensive care nurses regarding delirium assessment and to compare practices for assessing delirium with practices for assessing sedation.
Methods A paper/Web-based survey was administered to 601 staff nurses working in 16 intensive care units at 5 acute care hospitals with sedation guidelines specifying delirium assessment in the Boston, Massachusetts area.
Results Overall, 331 nurses (55%) responded. Only 3% ranked delirium as the most important condition to evaluate, compared with altered level of consciousness (44%), presence of pain (23%), or improper placement of an invasive device (21%). Delirium assessment was less common than sedation assessment (47% vs 98%, P < .001) and was more common among nurses who worked in medical intensive care units (55% vs 40%, P = .03) and at academic centers (53% vs 13%, P < .001). Preferred methods for assessing delirium included assessing ability to follow commands (78%), checking for agitation-related events (71%), the Confusion Assessment Method for the Intensive Care Unit (36%), the Intensive Care Delirium Screening Checklist (11%), and psychiatric consultation (9%). Barriers to assessment included intubation (38%), complexity of the tool for assessing delirium (34%), and sedation level (13%).
Conclusions Practice and perceptions of delirium assessment vary widely among critical care nurses despite the presence of institutional sedation guidelines that promote delirium assessment.