Intensive care medicine
-
Intensive care medicine · Sep 2010
Comparative StudyImpact of nosocomial infections on clinical outcome and resource consumption in critically ill patients.
Nosocomial infections still present a major problem in intensive care units (ICUs), accounting for prolonged ICU and hospital stays and worsened outcomes. There exist differences in the literature regarding the impact of nosocomial infections on attributable mortality and resource consumption. The aim of this study was to observe these effects in a large cohort of critically ill patients. ⋯ We conclude that significant attributable mortality for several nosocomial infections exists in a large cohort of critically ill patients, with the highest impact occurring in those with microbiologically diagnosed pneumonia and combined infections. All infections were associated with an increased resource consumption. Effective infection control measures could improve both clinical outcome and proper and effective use of ICU resources.
-
Intensive care medicine · Sep 2010
ReviewPregnant and postpartum admissions to the intensive care unit: a systematic review.
To determine the incidence and characteristics of pregnant and postpartum women requiring admission to an intensive care unit (ICU). ⋯ ICU admission of pregnant and postpartum women occurs infrequently, with obstetric conditions responsible for the majority of ICU admissions. The ICU admission profile of women was similar in developed and developing countries; however, the maternal mortality rate remains higher for ICUs in developing countries, supporting the need for ongoing service delivery improvements. More studies are required to determine the impact of ICU admission for pregnant and postpartum women.
-
Intensive care medicine · Sep 2010
Randomized Controlled TrialProbiotics in the critically ill patient: a double blind, randomized, placebo-controlled trial.
Probiotics have been shown to be able to restore a non-pathogenic digestive flora, to prevent digestive colonization by pathogenic bacteria, and to modulate immunity. The aim of this study was to assess the effects of prophylactic probiotic administration in patients ventilated for up to 2 days. ⋯ Although numerous uncertainties remain (type and the number of strains to use, delay and length of administration), and despite an acceptable safety profile, the daily prophylactic administration of probiotics cannot be encouraged in the critically ill patient.
-
Intensive care medicine · Sep 2010
Review Meta AnalysisDiagnostic accuracy of passive leg raising for prediction of fluid responsiveness in adults: systematic review and meta-analysis of clinical studies.
To systematically review the published evidence on the ability of passive leg raising-induced changes in cardiac output (PLR-cCO) and in arterial pulse pressure (PLR-cPP) to predict fluid responsiveness. ⋯ Passive leg raising-induced changes in cardiac output can reliably predict fluid responsiveness regardless of ventilation mode and cardiac rhythm. PLR-cCO has a significantly higher predictive value than PLR-cPP.
-
Intensive care medicine · Sep 2010
Multicenter Study Clinical TrialImplementing glucose control in intensive care: a multicenter trial using statistical process control.
Glucose control (GC) with insulin decreases morbidity and mortality of critically ill patients. In this study we investigated GC performance over time during implementation of GC strategies within three intensive care units (ICUs) and in routine clinical practice. ⋯ There are various strategies to achieve GC in routine clinical practice but with variable success. All of them were associated with an increase in hypoglycemia events, but GC was never stopped. Instead, these events have been accepted and managed. Statistical process control is a useful tool for monitoring phenomena over time and captures within-institution changes.