Articles: hospitals.
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Curr Opin Anaesthesiol · Dec 2023
ReviewInitiatives to detect and prevent death from perioperative deterioration.
This study indicates that there are differences between hospitals in detection, as well as in adequate management of postsurgical complications, a phenomenon that is described as 'failure-to-rescue'.In this review, recent initiatives to reduce failure-to-rescue in the perioperative period are described. ⋯ Improving the complete emergency chain, including monitoring, recognition and response in the afferent limb, as well as diagnostic and treatment in the efferent limb, should lead to reduced failure-to-rescue situations in the perioperative period.
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Curr Opin Crit Care · Dec 2023
ReviewPrevention and management of antibiotic associated acute kidney injury in critically ill patients: new insights.
Drug associated kidney injury (D-AKI) occurs in 19-26% of hospitalized patients and ranks as the third to fifth leading cause of acute kidney injury (AKI) in the intensive care unit (ICU). Given the high use of antimicrobials in the ICU and the emergence of new resistant organisms, the implementation of preventive measures to reduce the incidence of D-AKI has become increasingly important. ⋯ The use of both old and new antimicrobials is increasingly important in combating the rise of resistant organisms. Advances in technology, such as artificial intelligence, and alternative formulations of traditional antimicrobials offer promise in reducing the incidence of D-AKI, while antioxidant medications may aid in minimizing nephrotoxicity. However, maintaining haemodynamic stability using isotonic fluids, drug monitoring, and reducing nephrotoxic burden combined with vigilant antimicrobial stewardship remain the core preventive measures for mitigating D-AKI while optimizing effective antimicrobial therapy.
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Sickle cell anemia (SCA), a hereditary blood disorder characterized by the presence of abnormal hemoglobin, poses a unique set of challenges for both patients and healthcare providers. One of the most pressing issues in the care of these individuals is the persistent threat of nosocomial infections, which are infections acquired during hospitalization. This abstract provides a concise overview of the ongoing challenge of nosocomial infections in SCA patients, highlighting the factors contributing to their vulnerability and the preventive measures in place. ⋯ To address this challenge, healthcare facilities have implemented infection control protocols, vaccination strategies, and antimicrobial stewardship, emphasizing the importance of patient education. Recognizing the gravity of this issue and adopting comprehensive preventive measures is crucial to improving the quality of care and patient outcomes in this vulnerable population. Further research and ongoing efforts are essential to reducing the burden of nosocomial infections in SCA patients and enhancing their overall healthcare experience.
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Cochrane Db Syst Rev · Nov 2023
ReviewConfusion Assessment Method for the Intensive Care Unit (CAM-ICU) for the diagnosis of delirium in adults in critical care settings.
Delirium is an underdiagnosed clinical syndrome typified by an acute alteration of mental state. It is an important problem in critical care and intensive care units (ICU) due to its high prevalence and its association with adverse outcomes. Delirium is a very distressing condition for patients, with a huge impact on their well-being. Diagnosis of delirium in the critical care setting is challenging. This is especially true for patients who are mechanically ventilated and are therefore unable to engage in a verbal interview. The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) is a tool specifically designed to assess for delirium in the context of ICU patients, including those on mechanical ventilation. CAM-ICU can be administered by non-specialists to give a dichotomous delirium present/absent result. ⋯ The CAM-ICU tool may have a role in the early identification of delirium, in adult patients hospitalized in intensive care units, including those on mechanical ventilation, when non-specialized, properly trained clinical personnel apply the CAM-ICU. The test is most useful for exclusion of delirium. The test may miss a proportion of patients with incident delirium, therefore in situations where detection of all delirium cases is desirable, it may be best to repeat the test or combine CAM-ICU with another assessment. Future studies should compare different screening tests proposed for bedside assessment of delirium, as this approach will reveal which tool yields superior accuracy. In addition, future studies should consider and report the flow and timing of the tests and clearly report key characteristics related to patient selection. Finally, future research should focus on the impact of CAM-ICU screening on patient outcomes.