Journal of critical care
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Journal of critical care · Oct 2011
Clinical TrialReduction in ventilator associated pneumonia in a mixed intensive care unit after initiation of a novel hand hygiene program.
Healthcare-associated infections (HCAIs) impact 10% of hospitalized patients. Some of these infections result from bacterial cross contamination and poor compliance with guidelines (Pittet D: Compliance with hand disinfection and its impact on hospital-acquired infections. J HospInfect 48 Suppl A:S40-S46, 2001); (Watanakunakorn C, Wang C, Hazy J: An observational study of hand washing and infection control practices by healthcare workers. Infect Control Hosp Epidemiol 19:858-860, 1998). Contamination of provider hands may be a modifiable risk factor. We instituted a novel multimodal system designed to improve hand hygiene by ICU providers. ⋯ A novel multi-modal hand hygiene system resulted in a reduction in VAP. Provider hand contamination during patient care in the ICU is a modifiable risk factor for reducing ventilator associated pneumonias.
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Journal of critical care · Oct 2011
Case ReportsProlonged acute care in a 52-year-old man with respiratory failure: lessons learned from 70-day intensive care unit hospitalization.
This study was undertaken to record the experiences of a patient who survived prolonged intensive care unit (ICU) care secondary to acute respiratory failure. ⋯ Patient debriefing may improve outcomes after prolonged acute care. Current survey instruments provide a good estimate of a patient's mental status. Patients themselves can provide important information about hospital care and areas needing improvement.
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Journal of critical care · Oct 2011
Vasopressor administration and sepsis: a survey of Canadian intensivists.
Patients with septic shock often receive intravenous vasopressor infusions, with little evidence available to guide their titration. We surveyed Canadian intensivists to document self-reported vasopressor titration strategies for patients with septic shock. ⋯ Self-reported vasopressor use for the treatment of septic shock is relatively uniform among Canadian intensivists; however, practice is variable in patients with chronic comorbidities or acute concurrent illnesses.
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Journal of critical care · Oct 2011
Comparative StudyBloodstream infection after elective liver transplantation is associated with increased mortality in patients with cirrhosis.
This study aims to investigate what factors predict the development of postoperative bloodstream infection (BSI) in patients transplanted electively for chronic liver disease and compare outcomes in infected transplant recipients (BCLD) with noninfected patients (CLD). ⋯ Bloodstream infection post-LT was associated with increased severity of illness on admission, greater requirements for organ support, and increased mortality.
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Journal of critical care · Oct 2011
The impact of coagulation parameters on the outcomes of patients with severe community-acquired pneumonia requiring intensive care unit admission.
Coagulation abnormalities are frequent in patients with severe infections. However, the predictive value of d-dimer and of the presence of associated coagulation derangements in severe community-acquired pneumonia (CAP) remains to be thoroughly evaluated. The aim of this study was to investigate the predictive value of coagulation parameters in patients with severe CAP admitted to the intensive care unit. ⋯ d-Dimer levels are good predictors of outcome in severe CAP and may augment the predictive ability of scoring systems as APACHE II and SOFA.