Search Tag: ICU
Optimal-approach-to-fluid-resuscitation-for-patients-in-shock
2020 03 Feb
Initial fluid resuscitation practices for patients with haemodynamic shock remain controversial. There is significant variability in these practices, and the impact of this is still poorly understood. Overall, non-patient-centred resuscitation practices, conflicting treatments, variability, and failure to meet targets for initial resuscitation are...Read more
Peptic-trial-preventing-stress-ulcers-in-icu-patients
2020 26 Jan
Approximately 2.5% of adults acutely admitted to an ICU develop upper gastrointestinal bleeding. 70% of these patients are prescribed stress ulcer prophylaxis. Proton pump inhibitors are the most commonly prescribed drugs as they reduce bleeding risk. However, there are some clinicians who prescribe histamine-2 receptor blockers. But this practice...Read more
Using-biomarkers-for-mortality-prediction-in-patients-with-sepsis
2019 23 Nov
Sepsis has always carried high mortality. Even today, with all the latest technology and newer antibiotics, sepsis continues to be a major risk factor for death. It is important to understand that the earlier sepsis is diagnosed and treated, the better the prognosis. Each year, nearly 6 million people die of sepsis in the US. Because of its aggressive...Read more
Cognitive-impairment-after-ards
2019 22 Nov
Acute respiratory distress syndrome (ARDS) is a serious disorder that causes severe hypoxia requiring mechanical ventilation. It affects approximately 200,000 patients in the US each year, accounting for 10% of ICU admissions and a mortality risk of 25-40%. In many cases, patients also develop dysfunction of other organs that leads to high morbidity...Read more
Machine-learning-to-predict-severe-sepsis-and-septic-shock
2019 21 Oct
Sepsis is a major cause of death among hospitalised patients. It affects nearly 6% of all admissions and results in in-hospital mortality of greater than 15%. Early detection could reduce mortality, as it would result in the timely implementation of evidence-based interventions. Clinical researchers have developed and implemented a machine-learning...Read more
Challenges-in-the-management-of-the-critically-ill-patient
2019 26 Sep
Interview with Massimo Antonelli, Professor of Intensive Care and Anaesthesiology, Università Cattolica del Sacro Cuore, Rome, Italy Massimo Antonelli is a Professor of Intensive Care and Anesthesiology at the Università Cattolica del Sacro Cuore, Rome, Italy. He serves as the Director of the Dept. of Anesthesiology and Intensive Care and Emergency...Read more
Machine-learning-based-prediction-models-for-aki
2019 23 Aug
Acute Kidney Injury (AKI) is a common occurrence for critically ill patients in the ICU, and its early diagnosis has proven to be challenging. The accuracy of the online, machine-learning-based prediction model, AKIpredictor , was analysed for its use in a clinical setting. The study, which took place over five ICUs in Belgium, compared the predictions...Read more
Effects-of-sedatives-and-opioids-on-patient-ventilator-asynchrony
2019 09 Jul
Patient-ventilator asynchrony is frequent during invasive mechanical ventilation. If patient-ventilator interaction is poor, it can prolong the duration of mechanical ventilation and can also result in longer ICU and hospital stay as well as increased mortality. It is thus important to optimise patient-ventilator interaction. There are many factors...Read more
Nighttime-intensivist-staffing
2019 03 Jul
The work hours and sleep schedules of physicians who have completed training have seldom been studied. But there is ample evidence that suggests that sleep deprivation can cause errors in decision-making even in easy and familiar circumstances. Keeping in mind that the critical care setting is usually quite stressful, long working hours and sleep...Read more
Outcomes-of-abcde-bundle-in-mechanically-ventilated-patients
2019 26 Jun
Increasing focus on ICU utilisation and survivorship has also resulted in a greater focus on the long-term consequences of critical illness. Post Intensive Care Syndrome (PICS) is characterised by physical, cognitive, and emotional manifestations and can have a long-lasting impact on survivors of ICU as well as their families and caregivers. ...Read more
Fluid-responsiveness-in-sepsis-the-fluid-challenge-revisiting-fcrev-study
2019 23 May
Fluid challenge is a common practice in the ICU. It is one of the most important resuscitation manoeuvres of acute circulatory failure management in critically ill patients. Adequate fluid resuscitation is very important because both hypovolaemia and fluid overload can result in poor outcomes in the ICU. The criteria for fluid administration...Read more
Treatment-implications-of-novel-clinical-phenotypes-for-sepsis
2019 23 May
Sepsis affects millions of individuals every year. It carries a high risk of death, even if prompt care is provided. It has been decades, and no new therapies for sepsis have been discovered. A major barrier to progress in this area has been the overly broad definition for this syndrome. Sepsis has a vast array of clinical and biological features,...Read more
Perfect-protocol-volume-based-feeding-in-ventilated-adults
2019 16 Apr
Underfeeding in critical illness is common and associated with poor outcomes. Researchers in the UK designed a before-and-after study to evaluate the safety, efficacy and clinical outcomes associated with volume-based feeding (VBF) compared to rate-based feeding (RBF) in a single intensive care unit (ICU). The prospective before-and-after study...Read more
A-third-party-partner-for-critical-care
2019 15 Jan
Challenges and advantages of engaging a clinical staffing and management service for your ICU Trusting a third-party partner to staff and manage your ICU isn’t a decision to be made lightly. Your hospital’s reputation is at stake. Even more important, so are your patients’ health and safety. Finding the right partner to help you deliver...Read more
How-effective-are-icu-telemedicine-programmes
2018 07 Nov
Critical care is both resource intensive and costly, consuming nearly 15 percent of all hospital costs in the United States. With the demand for critical care outpacing the supply of intensivists in the setting of the ageing U.S. population, ICU telemedicine has been proposed as an intervention that may help alleviate this workforce crisis....Read more
Vitamin-d-and-critical-illness
2018 30 Oct
Vitamin D deficiency – usually defined as 25(OH)D levels below 20ng/ml – is common in critical illness with prevalence between 40-70%. Many observational studies have shown a link between low vitamin D levels and poor clinical outcomes in critically ill adults and children, including excess mortality and morbidity such as acute kidney injury, acute...Read more
Pct-guided-antibiotic-treatment-improves-outcomes-in-sepsis-patients
2018 22 Aug
Procalcitonin (PCT)-guided antibiotic treatment in ICU patients with infection and sepsis patients results in improved survival and reduced antibiotic treatment duration, according to results of a new meta-analysis published in the journal Critical Care. Early identification of sepsis and appropriate initial management including the start of...Read more
Improving-the-long-term-outcomes-after-critical-illness
2018 22 Aug
Heterogeneity in studies of survivors of critical illness limits knowledge of outcomes in this patient population. Conceptual models of outcomes developed in other fields can be used to better understand outcomes after critical illness, says Nathan E. Brummel, MD, MSCI, Department of Medicine, Vanderbilt University Medical Center, Center for Quality...Read more
Personalised-care-to-improve-glycaemic-control-in-critically-ill-patients
2018 08 Aug
Hyperglycaemia is prevalent in critical care, caused by a complex interaction of multiple feedback loops associated with inflammation as a result of immune responses, counter-regulatory responses, and high blood glucose itself. However, glycaemic control (GC) currently leads to increased hypoglycaemia, independently associated with a greater risk...Read more
Machine-learning-algorithm-more-accurate-in-predicting-icu-readmission
2018 06 Jun
New research shows that a machine learning approach to predicting ICU readmission was significantly more accurate than previously published algorithms or prediction tools. Implementation of this approach could target patients who may benefit from additional time in the ICU or more frequent monitoring after transfer to the hospital ward, according...Read more
Pre-icu
2018 01 Jun
What happens before patients arrive in the ICU? We know that status pre-ICU is associated with outcomes after patients leave the ICU. We also know that we want patients to come to the ICU only if it is needed. This ties in to having an adequate emergency medicine system and innovative techniques in trauma as well as monitoring hospital patients...Read more
Automated-system-detects-risk-of-ventilator-associated-pneumonia
2018 23 May
Researchers at Massachusetts General Hospital (MGH) have developed an automated system for identifying patients at risk for complications associated with the use of mechanical ventilators. The new system uses an algorithm that has been shown to be 100 percent accurate in identifying at-risk patients when provided with necessary data, according...Read more
Isicem18-what-you-need-to-know-about-icu-cost-control
2018 27 Mar
Controlling ICU costs requires good interdisciplinary communication and optimised resource allocation and use. It does not mean that patient outcomes will be compromised. Taking on budgeting can be daunting, but there are key points to bear in mind, according to Jukka Takala, professor of Intensive Care Medicine in the University of Bern, Switzerland,...Read more
Should-empiric-antibiotic-therapy-be-considered-old-fashioned
2018 26 Mar
The Surviving Sepsis Campaign recommends starting empiric broad-spectrum antibiotics in the initial management of patients with severe sepsis and septic shock (Rhodes et al. 2017). As a consequence, many patients receive unnecessary antibiotics, exposing them to adverse events, while others might be undertreated in spite of broad-spectrum therapy...Read more
Caring-for-critically-ill-immunocompromised-patients
2018 16 Mar
We can do better! Élie Azoulay, MD, PhD, is Professor of Medicine in Specialty Pulmonary Medicine and Critical Care at Saint Louis Teaching Hospital and Université Paris Diderot in France. He is the Director of the medical intensive care unit (ICU). He leads the French programme for the care of critically ill immunocompromised patients, and is...Read more
Supervised-machine-learning-predicts-clabsi
2018 06 Mar
Machine learning has proven to be useful for developing prediction models for outcomes in intensive care unit patients. A new study comparing machine learning techniques for predicting central line-associated bloodstream infection (CLABSI) shows supervised artificial intelligence can accurately predict CLABSI in patients admitted to the ICU. Early...Read more
Real-time-surveillance-of-influenza-morbidity
2017 13 Dec
Morbidity and mortality associated with influenza are routinely analysed retrospectively. The Centers for Disease Control and Prevention also releases weekly data on hospitalisations and mortality due to lab-confirmed cases of influenza. In addition, through its online Influenza Hospitalization Surveillance Network (FluSurv-NET), CDC provides...Read more
Making-critical-care-education-basic-a-collaborative-approach-to-training
2017 22 Nov
This article highlights the key current challenges of intensive care training and education. We share our experience of utilising modern educational techniques through the BASIC Collaboration to facilitate global critical care training. Critical care is a young and rapidly expanding specialty. This brings particular challenges in training staff....Read more
Effective-education-for-palliative-care-communication-as-a-procedure
2017 22 Nov
Palliative care for critically ill patients in the intensive care unit is increasingly in the mainstream, and palliative care principles are vital to ensure comprehensive patient care. ICU Management & Practice spoke to Caroline J. Hurd, MD, Director of Education Operations at UW Cambia Palliative Care Center of Excellence, about the purpose of...Read more
Integration-of-nurse-practitioners-into-the-critical-care-team
2017 22 Nov
A viable approach to meet pressing challenges As the demands of critical care medicine increase one viable option to meet needs is the addition of a nurse practitioner to the traditional structure of the critical care team. The purpose of this article is to convey our positive experience of physician and nurse practitioner integration...Read more