2009 Sep - Study of prone positioning to reduce ventilator-associated pneumonia in hypoxemic patients.

Mounier R, Adrie C, Français A, Garrouste-Orgeas M, Cheval C, Allaouchiche B, Jamali S, Dinh-Xuan AT, Goldgran-Toledano D, Cohen Y, Azoulay E, Timsit JF, Ricard JD; on behalf of the Outcomerea Study Group.; Eur Respir J. 2009 Sep 9. [Epub ahead of print]
Whether prone positioning (PP) affects ventilator associated-pneumonia (VAP) and mortality in patients with acute lung injury/adult respiratory distress syndrome. 2409 prospectively included patients admitted over 9 years (2000-2008) to 12 French ICUs (OUTCOMEREA((R))), who required invasive mechanical ventilation (MV) and had Pa,O2/FiO2 ratios <300 during the first 48 hours. Controls were matched to PP patients on the PP propensity score (+/-10%), MV duration >/= that in PP patients before the first turn prone, and centre.

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2009 Sep - Hypertonic saline in critical care: a review of the literature and guidelines for use in hypotensive states and raised intracranial pressure [Review]

Strandvik GF.; Anaesthesia. 2009 Sep;64(9):990-1003.

Hypertonic saline has been in clinical use for many decades. Its osmotic and volume-expanding properties make it theoretically useful for a number of indications in critical care. This literature review evaluates the use of hypertonic saline in critical care.

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2009 Sep - Brachial artery peak velocity variation to predict fluid responsiveness in mechanically ventilated patients

Monge Garcia MI, Gil Cano A, Diaz Monrove JC.; Crit Care. 2009 Sep 3;13(5):R142. [Epub ahead of print]
INTRODUCTION: Although several parameters have been proposed to predict the hemodynamic response to fluid expansion in critically ill patients, most of them are invasive or require the use of special monitoring devices. The aim of this study is to determine whether noninvasive evaluation of respiratory variation of brachial artery peak velocity flow measured using Doppler ultrasound could predict fluid responsiveness in mechanically ventilated patients.

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2009 Jun - Clinical review: RIFLE and AKIN--time for reappraisal.

Cruz DN, Ricci Z, Ronco C.;Crit Care. 2009;13(3):211. Epub 2009 Jun 25. 

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.

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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

Hampshire PA, Welch CA, McCrossan LA, Francis K, Harrison DA.; Crit Care. 2009 Aug 25;13(4):R137. [Epub ahead of print]
INTRODUCTION: Patients with haematological malignancy admitted to intensive care have a high mortality. Adverse prognostic factors include the number of organ failures, invasive mechanical ventilation and previous bone marrow transplantation. Severity-of-illness scores may underestimate the mortality of critically ill patients with haematological malignancy. This study investigates the relationship between admission characteristics and outcome in patients with haematological malignancies admitted to intensive care units (ICU) in England, Wales and Northern Ireland, and assesses the performance of three severity-of-illness scores in this population.

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2009 Sep - Extracorporeal life support in severe drug intoxication: a retrospective cohort study of seventeen cases

Daubin C, Lehoux P, Ivascau C, Tasle M, Bousta M, Lepage O, Quentin C, Massetti M, Charbonneau P.; Crit Care. 2009 Aug 25;13(4):R138. [Epub ahead of print]
INTRODUCTION: Cardiovascular failure is the leading cause of death in severe acute drug intoxication. In this setting, we report the feasibility, complications, and outcome of emergency extracorporeal life support (ECLS) in refractory shock or cardiac arrest following a drug overdose.

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2009 Vasopressin use is associated with death in acute trauma patients with shock

Collier B, Dossett L, Mann M, Cotton B, Guillamondegui O, Diaz J, Fleming S, May A, Morris J.; J Crit Care. 2009 Aug 12. [Epub ahead of print]
PURPOSE: Traumatic hemodynamic instability is associated with high mortality if not expeditiously corrected. Hypotension despite adequate volume resuscitation is treated with vasopressors. Although catecholamines are typically the first agent used, arginine vasopressin (AVP) is increasingly been used as an adjuvant agent. Mortality with refractory hypotension and vasopressin use in trauma patients is unknown.

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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.

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2009 Outcomes of patients admitted to the intensive care unit with idiopathic pulmonary fibrosis

Rangappa P, Moran JL.; Crit Care Resusc. 2009 Jun;11(2):102-9.
OBJECTIVE: To evaluate outcomes of patients admitted to an intensive care unit with idiopathic pulmonary fibrosis (IPF) and acute respiratory deterioration.

Fig. HRCT thorax of idopathic pulmonary fibrosis (Photo courtesy of Dr HP Shum, PYNEH)

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2009 Mannitol or hypertonic saline for intracranial hypertension? A point of view

Castillo LB, Bugedo GA, Paranhos JL.; Crit Care Resusc. 2009 Jun;11(2):151-4.
Osmotically active solutions, particularly mannitol, have been used for more than 30 years in the treatment of intracranial hypertension. Recently hypertonic saline has emerged as an alternative to mannitol. Both solutions are used worldwide, and their indications and long-term side effects are well known.

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2009 Overuse of stress ulcer prophylaxis in the critical care setting and beyond

Farrell CP, Mercogliano G, Kuntz CL.; J Crit Care. 2009 Aug 14.

BACKGROUND: Patients admitted to the intensive care unit (ICU) are susceptible to stress ulcers. We hypothesize that despite recommendations, stress ulcer prophylaxis (SUP) is still overused in the ICU and often continued after resolution of risk factors for bleeding.

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2009 Using Medical Emergency Teams to detect preventable adverse events

Iyengar A, Baxter A, Forster AJ.;Crit Care. 2009 Jul 30;13(4):R126

INTRODUCTION: Medical Emergency Teams (MET), also known as Rapid Response Teams, are recommended as a patient safety measure. A potential benefit of implementing an MET is the capacity to systematically assess preventable adverse events, which are defined as poor outcomes caused by errors or system design flaws. We describe how we used MET calls to systematically identify preventable adverse events in an academic tertiary care hospital, and describe our surveillance results.

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2009 Delivered dose of renal replacement therapy and mortality in critically ill patients with acute kidney injury

Sergio Vesconi , Dinna N Cruz , Roberto Fumagalli , Detlef Kindgen-Milles , Gianpaola Monti , Anibal Marinho , Filippo Mariano , Marco Formica , Mariano Marchesi , Robert Rene , Sergio Livigni , Claudio Ronco and The DO-RE-MI Study Group

Critical Care 2009, 13:R57doi:10.1186/cc7784; Published: 15 April 2009

Abstract (provisional)

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.

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2008 Fat Embolism Syndrome

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.

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2008 Assessment of Delirium in the Intensive Care Unit: Nursing Practices and Perceptions

John W. Devlin, PharmD, BCPS; Jeffrey J. Fong, PharmD, BCPS; Elizabeth P. Howard, RN, PhD, ACNP; Yoanna Skrobik, MD; Nina McCoy, RN; Cyndi Yasuda, MSN, CCRN; John Marshall, PharmD
Am J Crit Care.  2008;17(6):555-565, 576.  ©2008 American Association of Critical-Care Nurses


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.