Critical care : the official journal of the Critical Care Forum
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Comparative Study
Changes in hospital costs after introducing an intermediate care unit: a comparative observational study.
The high cost of critical care resources has resulted in strategies to reduce the costs of ruling out low-risk patients by developing intermediate care units (IMCs). The aim of this study was to compare changes in total hospital costs for intensive care patients before and after the introduction of an IMC at the University Hospital Maastricht. ⋯ After the introduction of the IMC, the higher mean total hospital costs for patients with a high TISS score and longer ICU stay explained the cost increase.
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Editorial Comment
Fluid balance as a biomarker: impact of fluid overload on outcome in critically ill patients with acute kidney injury.
Fluid therapy is fundamental to the acute resuscitation of critically ill patients. In general, however, early and appropriate goal-directed fluid therapy contributes to a degree of fluid overload in most if not all patients. Recent data imply that a threshold may exist beyond which, after acute resuscitation, additional fluid therapy may cause harm. ⋯ Few studies have examined the impact of fluid balance on clinical outcomes in critically ill adults with acute kidney injury. Payen and coworkers, in a secondary analysis of the SOAP (Sepsis Occurrence in Acutely Ill Patients) study, now present evidence that there is an independent association between mortality and positive fluid balance in a cohort of critically ill patients with acute kidney injury. In this commentary, we discuss these findings within the context of prior literature and propose that assessment of fluid balance should be considered as a potentially valuable biomarker of critical illness.
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Multicenter Study
Combined didactic and scenario-based education improves the ability of intensive care unit staff to recognize delirium at the bedside.
While nurses play a key role in identifying delirium, several authors have noted variability in their ability to recognize delirium. We sought to measure the impact of a simple educational intervention on the ability of intensive care unit (ICU) nurses to clinically identify delirium and to use a standardized delirium scale correctly. ⋯ A simple composite educational intervention incorporating script concordance theory improves the capacity for ICU nurses to screen for delirium nearly as well as experts. Self-reporting by nurses of completion of delirium screening may not constitute an adequate quality assurance process.
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Comparative Study
Gastrointestinal failure score in critically ill patients: a prospective observational study.
There are no universally accepted diagnostic criteria for gastrointestinal failure in critically ill patients. In the present study we tested whether the occurrence of food intolerance (FI) and intra-abdominal hypertension (IAH), combined in a 5-grade scoring system for assessment of gastrointestinal function (the Gastrointestinal Failure [GIF] score), predicts mortality. The prognostic value of the GIF score alone and in combination with the Sequential Organ Failure Assessment (SOFA) score is evaluated, and the incidence and outcome of gastrointestinal failure is described relative to the GIF score. ⋯ The GIF score is useful for classifying information on the gastrointestinal system. The mean GIF score during the first 3 days in the ICU had high prognostic value for ICU mortality. Development of gastrointestinal failure is associated with significantly impaired outcome.
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Comparative Study
Induction of Bim and Bid gene expression during accelerated apoptosis in severe sepsis.
In transgenic animal models of sepsis, members of the Bcl-2 family of proteins regulate lymphocyte apoptosis and survival of sepsis. This study investigates the gene regulation of pro-apoptotic and anti-apoptotic members of the Bcl-2 family of proteins in patients with early stage severe sepsis. ⋯ In early severe sepsis a gene expression pattern with induction of the pro-apoptotic Bcl-2 family members Bim, Bid and Bak and a downregulation of the anti-apoptotic Bcl-2 and Bcl-xl proteins was observed in peripheral blood. This constellation may affect cellular susceptibility to apoptosis and complex immune dysfunction in sepsis.