Critical care medicine
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Critical care medicine · Oct 2014
Comparative StudyICU architectural design affects the delirium prevalence: a comparison between single-bed and multibed rooms*.
Delirium risk factors are related to the patients' acute and chronic clinical condition, treatment, and environment. The environmental risk factors are essentially determined by the ICU architectural design. Although there are countless architectural variations among the ICUs, all can be classified as single- or multibed rooms. Our objectives were to compare the ICU delirium prevalence and characteristics (coma/delirium-free days, first day in delirium, and delirium motoric subtypes) of critically ill patients admitted in single- or multibed rooms. ⋯ Critically ill patients admitted in single-bed rooms have a lower prevalence of delirium than those admitted in multibed rooms. However, coma/delirium-free days, first day in delirium, and motoric subtypes were not different.
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Critical care medicine · Oct 2014
Horizontal Infection Control Strategy Decreases Methicillin-Resistant Staphylococcus aureus Infection and Eliminates Bacteremia in a Surgical ICU Without Active Surveillance.
Methicillin-resistant Staphylococcus aureus infection is a significant contributor to morbidity and mortality in hospitalized patients worldwide. Numerous healthcare bodies in Europe and the United States have championed active surveillance per the "search and destroy" model. However, this strategy is associated with significant economic, logistical, and patient costs without any impact on other hospital-acquired pathogens. We evaluated whether horizontal infection control strategies could decrease the prevalence of methicillin-resistant S. aureus infection in the ICU, without the need for active surveillance. ⋯ Aggressive multifaceted horizontal infection control is an effective strategy for reducing the prevalence of methicillin-resistant S. aureus infection and eliminating methicillin-resistant S. aureus bacteremia in the ICU without the need for active surveillance and decontamination.
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Critical care medicine · Oct 2014
Observational StudyGlobal Prospective Epidemiologic and Surveillance Study of Ventilator-Associated Pneumonia due to Pseudomonas aeruginosa.
To estimate the prevalence of ventilator-associated pneumonia caused by Pseudomonas aeruginosa in patients at risk for ventilator-associated pneumonia and to describe risk factors for P. aeruginosa ventilator-associated pneumonia. ⋯ Our findings suggest that ventilator-associated pneumonia remains a common ICU infection and that P. aeruginosa is one of the most common causative pathogens. The odds of developing P. aeruginosa ventilator-associated pneumonia were eight times higher in patients with prior P. aeruginosa colonization than in uncolonized patients, which in turn was associated with local resistance.
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Critical care medicine · Oct 2014
Bayesian methodology for the design and interpretation of clinical trials in critical care medicine: a primer for clinicians.
To review Bayesian methodology and its utility to clinical decision making and research in the critical care field. ⋯ We propose that the application of the versatile Bayesian methodology in conjunction with the conventional statistical methods is not only ripe for actual use in critical care clinical research but it is also a necessary step to maximize the performance of clinical trials and its translation to the practice of critical care medicine.
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Critical care medicine · Oct 2014
Observational StudyImpact of Presenting Rhythm on Short- and Long-Term Neurologic Outcome in Comatose Survivors of Cardiac Arrest Treated With Therapeutic Hypothermia.
To compare short- and long-term neurologic outcomes in comatose survivors of out-of-hospital cardiac arrest treated with mild therapeutic hypothermia presenting with nonshockable versus shockable initial rhythms. ⋯ These data indicate an association between initial nonshockable rhythm and significantly worse short- and long-term outcomes in patients treated with mild therapeutic hypothermia. Among survivors, neurologic status significantly improved over time for all patients and shockable rhythm patients and tended to improve over time for the small number of nonshockable rhythm patients who survived beyond hospitalization. No significant interaction between changes in neurologic status over time and presenting rhythm was seen.