Articles: intensive-care-units.
-
Critical care medicine · Apr 2012
Multicenter StudyMeeting standards of high-quality intensive care unit palliative care: clinical performance and predictors.
High-quality care for intensive care unit patients and families includes palliative care. To promote performance improvement, the Agency for Healthcare Research and Quality's National Quality Measures Clearinghouse identified nine evidence-based processes of intensive care unit palliative care (Care and Communication Bundle) that are measured through review of medical record documentation. We conducted this study to examine how frequently the Care and Communication Bundle processes were performed in diverse intensive care units and to understand patient factors that are associated with such performance. ⋯ Across three intensive care units in this study, performance of key palliative care processes (other than pain assessment and management) was inconsistent and infrequent. Available resources and strategies should be utilized for performance improvement in this area of high importance to patients, families, and providers.
-
Intensive care delirium is a well-recognized complication in critically ill patients. Delirium is an independent risk factor for death in the intensive care unit (ICU), leading to oversedation, increased duration of mechanical ventilation, and increased length of stay. Although there has not been a direct causal relationship shown between sleep deprivation and delirium, many studies have demonstrated that critically ill patients have an altered sleep pattern, abnormal levels of melatonin, and loss of circadian rhythms. ⋯ However, there are only a few studies of melatonin in ICU patients and these use heterogeneous methodologies. Therefore, it is not possible at this stage to make any clear recommendations regarding the clinical use of melatonin in this setting. There is a need for well-designed randomized controlled trials examining the role of melatonin in ICU.
-
Clin. Microbiol. Infect. · Apr 2012
First influenza season after the 2009 pandemic influenza: characteristics of intensive care unit admissions in adults and children in Vall d'Hebron Hospital.
To assess potential differences in epidemiology and management of patients admitted with influenza infection in the intensive care unit (ICU) during the first post-pandemic influenza period. Observational prospective study comparing September 2009-January 2010 with September 2010-January 2011. Variables captured: demographics, co-morbidities, physiological parameters, outcomes and management. ⋯ Primary viral pneumonia predominated among ICU admissions. Postpandemic ICU influenza developed later, with some cases of influenza B, more frequent bacterial and viral co-infections and more patients with severe acute respiratory infection with normal chest X-ray. Increasing vaccination rates among risk-group individuals is warranted to prevent ICU admission and death.