Heart & lung : the journal of critical care
-
Comparative Study
Does race affect readmission to hospital after critical illness?
To examine the influence of race on 7-day hospital readmission rates after discharge of critically ill patients. ⋯ Contrary to our hypothesis, race was not associated with rapid readmission or mortality of critically ill patients. Factors independently associated with rapid readmission were mechanical ventilation beyond 29 days and disposition to an acute rehabilitation or skilled nursing facility. Further studies are required to ascertain whether these factors are generalizable or idiosyncratic to our institution.
-
Patients with heart failure require a great deal of information about their disease, but it is also important to know about their preferences for involvement in medical decision making and about factors that may influence their preferences so that patients' needs, values, and preferences can be met by clinicians. ⋯ The results suggest that the preferences of patients with heart failure for a more passive role in decision making may be a stronger independent predictor of patients' perceived involvement in decision making than patients' age.
-
Patients in intensive care units (ICUs) can be adversely affected by distressing symptoms. When critically ill patients are unable to self-report symptoms, ICU nurses become proxy reporters. ⋯ Critically ill patients experience a broad range of symptoms. Continued attempts to validate nonverbal measures of symptoms are warranted because lack of such measures may adversely affect symptom treatment for critically ill patients. Furthermore, heightened awareness and increased education of nurses to differentiate between signs and symptoms lay the foundation for increasing attention on symptoms, improving accuracy of symptom assessment, and guiding appropriate symptom management.
-
Fevers of unknown origin (FUOs) are defined as prolonged fevers of 101 degrees F or greater lasting 3 or more weeks that remain undiagnosed after comprehensive inpatient/outpatient laboratory testing. Tick-borne infections are uncommon causes of FUOs. Any infectious disease accompanied by prolonged fevers can present as an FUO if the diagnosis is not suspected or if specific laboratory testing is not done to confirm the diagnosis. ⋯ He also had an elevated immunoglobulin-M Lyme titer indicating coinfection with Lyme disease. Although his hemolytic anemia persisted for weeks, he only had 3% parasitemia and intact splenic function. We believe this to be the first case of babesiosis presenting as an FUO in a normal host.
-
Case Reports
Persistent methicillin-resistant Staphylococcus aureus (MRSA) bacteremia due to a linezolid "tolerant" strain.
Persistent Staphylococcus aureus bacteremia is most frequently related to S. aureus acute bacterial endocarditis, myocardial abscess, extracardiac abscess, or a device-associated infection. Patients with continuous high-grade bacteremia who do not have acute bacterial endocarditis, an abscess, or a device-related infection should be considered to have antimicrobial "tolerance" as a possible cause. Antimicrobial "tolerance" is defined as a wide discrepancy between the minimal inhibitory concentration and the minimal bactericidal concentration of an isolate. ⋯ The lack of bactericidal activity of the antibiotic becomes apparent when minimal bactericidal concentrations are determined for "tolerant" strains, and there is a great discrepancy between the minimal inhibitory concentration being used. Antibiotic tolerance to S. aureus has been described with a variety of antibiotics. To the best of our knowledge, this is the first case of continuous, high-grade methicillin-resistant S. aureus bacteremia due to a linezolid-tolerant strain.