Debby B.D.,Infectious Diseases Unit |
Ganor O.,Infectious Diseases Unit |
Yasmin M.,Infectious Diseases Unit |
David L.,General Intensive Care Unit |
And 5 more authors.
European Journal of Clinical Microbiology and Infectious Diseases | Year: 2012
Carbapenem-resistant Klebsiella pneumoniae (CRKP) has emerged during recent years in several intensive care units. The objective of our study was to determine the incidence of CRKP and the risk factors associated with acquisition during intensive care unit (ICU) stay. This prospective cohort study was conducted between May 2007 and April 2008 in a medical-surgical ICU at a tertiary medical center. Rectal surveillance cultures were obtained from patients on admission and twice weekly. Of screened patients, 7.0% (21/299) were CRKP colonized on admission to the ICU. One hundred eighty (81%) patients were screened at least twice. Of these, 48 (27%) patients acquired CRKP during ICU stay. Of the 69 CRKP colonized patients (both imported and ICU acquired), 29% (20/69) were first identified by microbiologic cultures, while screening cultures identified 49 patients (71%). Of these, 23 (47%) subsequently developed clinical microbiological cultures. Independent risk factors for CRKP acquisition included recent surgery (OR 7.74; CI 3.42-17.45) and SOFA score on admission (OR 1.17; CI 1-1.22). In conclusion, active surveillance cultures detected a sizable proportion of CRKP colonized patients that were not identified by clinical cultures. Recent surgical procedures and patient severity were independently associated with CRKP acquisition. © Springer-Verlag 2011.
Cappellini E.,Ospedale Nuovo San Giovanni di Dio |
Bambi S.,University of Florence |
Lucchini A.,General Intensive Care Unit |
Lucchini A.,University of Milan Bicocca |
Milanesio E.,University of Turin
Dimensions of Critical Care Nursing | Year: 2014
Aim: The aims of this study were to describe the current staus of intensive care unit (ICU) visiting hours policies internationally and to explore the influence of ICUs' open visiting policies on patients', visitors', and staff perceptions, as well as on patients' outcomes. Methods: A review of the literature was done through MEDLINE, EMBASE, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. The following keywords were searched: "visiting," "hours," "ICU," "policy," and "intensive care unit." Inclusion criteria for the review were original research paper, adult ICU, articles published in the last 10 years, English or Italian language, and available abstract. Results: Twenty-nine original articles, mainly descriptive studies, were selected and retrieved. In international literature, there is a wide variability about open visiting policies in ICUs. The highest percentage of open ICUs is reported in Sweden (70%), whereas in Italy there is the lowest rate (1%). Visiting hours policies and number of allowed relatives are variable, from limits of short precise segments to 24 hours and usually 2 visitors. Open ICUs policy/guidelines acknowledge concerns with visitor hand washing to prevent the risk of infection transmission to patients. Patients, visitors, and staff seem to be inclined to support open ICU programs, although physicians are more inclined to the enhancement of visiting hours than nurses. Discussion: The percentages of open ICUs are very different among countries. It can be due to local factors, cultural differences, and lack of legislation or hospital policy. There is a need for more studies about the impact of open ICUs programs on patients' mortality, length of stay, infections' risk, and the mental health of patients and their relatives. © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Ben-Ari J.,Dana Childrens Hospital |
Zimlichman E.,Harvard University |
Adi N.,General Intensive Care Unit |
Sorkine P.,Dana Childrens Hospital |
Sorkine P.,General Intensive Care Unit
Journal of Medical Engineering and Technology | Year: 2010
Primary objective: To assess the accuracy of the EverOn™ piezoelectric sensor based contactless heart rate and respiration rate monitoring system. Methods: Measurements of the Everon™ and reference devices were performed in a sleep lab and an intensive care unit (ICU) setting. One minute measurements by both the reference device and the Everon™ were averaged and compared. Accuracy was defined in accordance with industry criteria. Results: Respiration rate (RR) accuracy in the 41 children and 16 adults evaluated in the sleep lab was 93.1 and 90.6 respectively, and heart rate (HR) accuracy was 94.4 and 91.5 respectively. For the 42 ICU patients RR accuracy was 82.0 and 75 (versus end-tidal CO2 and manual respectively), while accuracy of HR was 94.0. The EverOn™ was found to be superior to the impedance technique in measuring RR. Conclusions:The system described was found to be accurate in accordance with regulatory and industry criteria. © 2010 Informa UK, Ltd.
Aya H.D.,General Intensive Care Unit |
Aya H.D.,St George's, University of London |
Cecconi M.,General Intensive Care Unit |
Cecconi M.,St George's, University of London
Current Opinion in Critical Care | Year: 2015
Purpose of review Most of our blood volume is contained in the venous compartment. The so-called 'compliant veins' are an adjustable blood reservoir, which is playing a paramount role in maintaining haemodynamic stability. The purpose of this study is to review what is known about this blood reservoir and how we can use this information to assess the cardiovascular state of critically ill patients. Recent findings The mean systemic filling pressure (Pmsf) is the pivot pressure of the circulation, and a quantitative index of intravascular volume. The Pmsf can be measured at the bedside by three methods described in critically ill patients. The Pmsf can be modified by the fluid therapy and vasoactive medications. Summary The Pmsf along with other haemodynamic variables can provide valuable information to correctly understand the cardiovascular status of critically ill patients and better manage the fluid therapy and cardiovascular support. Future studies using the Pmsf will show its usefulness for fluid administration. © 2015 Wolters Kluwer Health, Inc. All rights reserved.
PubMed | General Intensive Care Unit, Tel Aviv University, Infectious Disease Unit and Israel Institute for Biological Research
Type: | Journal: Disease models & mechanisms | Year: 2017
Pulmonary exposure to the plant toxin ricin, leads to respiratory insufficiency and death. To date, in-depth study of the functional disorders ensuing pulmonary intoxication, a prerequisite for establishing a clinically-relevant therapeutic protocol, is hampered by the lack of an appropriate animal model. To this end, we set up the pig, as a large animal model for the comprehensive study of the multifarious clinical manifestations of pulmonary ricinosis.Here we report for the first time, the monitoring of barometric whole body plethysmography for pulmonary function tests in non-anesthetized ricin-intoxicated pigs. Up to 30 hours post-exposure, as a result of progressing hypoxemia and to prevent carbon dioxide retention, animals exhibited a compensatory response of elevation in Minute Volume, attributed mainly to a robust elevation in respiratory rate with minimal response in tidal volume. This response was followed by decompensation, manifested by a descent in Minute Volume and severe hypoxemia, refractory to oxygen treatment. Radiological evaluation revealed evidence of early diffuse bi-lateral pulmonary infiltrates while hemodynamic parameters remained unchanged, excluding cardiac failure as an explanation for respiratory insufficiency. Ricin-intoxicated pigs suffered from increased lung permeability accompanied by cytokine storming while histological studies revealed lung tissue insults accumulating over time, up to the development of diffuse alveolar damage. Charting the decline in PaO2/FiO2 ratio in a mechanically-ventilated pig, confirmed that ricin-induced respiratory damage complies with the accepted diagnostic criteria for Acute Respiratory Distress Syndrome. The establishment of this animal model of pulmonary ricinosis, should assist us in our pursuit of efficient medical countermeasures, specifically-tailored to deal with the respiratory deficiencies stemming from ricin-induced Acute Respiratory Distress Syndrome.
Rubulotta F.,Imperial College London |
Moreno R.,Hospital Of Santo Antonio Dos Capuchos |
Rhodes A.,General Intensive Care Unit
Intensive Care Medicine | Year: 2011
Introduction: The European Union (EU) has created recent directives to facilitate the free movement of medical specialists in its member states. Methods: Analysis of two recent surveys performed in European countries. Results: Intensive Care Medicine training and accreditation have changed quickly over time. There is no harmonisation among European countries. Young specialists might face several difficulties in the future. Discussion: Nations providing a national examination for intensive care medicine and a national register for specialists in intensive care medicine facilitate the free movement of specialists, regardless of European regulations and directives. Conclusion: Intensive care medicine is currently not a mother speciality. A long process needs to occur before complete harmonization of training and accreditation and free movement of specialists in Europe will happen. © 2011 Copyright jointly held by Springer and ESICM.
Solomon A.W.,General Intensive Care Unit |
Bramall J.C.,General Intensive Care Unit |
Ball J.,St Georges Hospital
Anaesthesia | Year: 2011
Air swallowing can occur as a psychogenic phenomenon, because of abnormal anatomy, or during non-invasive positive pressure ventilation. Gross distension of the stomach with air can have severe consequences for the respiratory and gastrointestinal systems. We report the case of a 62-year-old man with severe dynamic hyperinflation due to chronic obstructive pulmonary disease, who developed respiratory failure requiring intubation a few hours after radical prostatectomy. Following a percutaneous tracheostomy and weaning of sedation on day six, his abdomen began to enlarge progressively. X-rays revealed massive gastric distension due to air swallowing, which continued despite all efforts to optimise therapy. The use of an underwater seal drainage system on a nasogastric tube improved ventilation and ultimately aided weaning from mechanical support. © 2010 The Authors.
Soroksky A.,General Intensive Care Unit |
Leonov Y.,General Intensive Care Unit
Nutritional Therapy and Metabolism | Year: 2012
Enteral nutrition of the critically ill is challenging and requires intimate awareness of the possible factors that may hamper the provision of calories via the enteral route. These factors include critical illness with hemodynamic instability that may interfere with gastrointestinal function and nutrition absorption. Other issues are the proper timing for starting enteral nutrition and the appropriate amount of calories to be delivered. In addition, gastrointestinal intolerance may further impede the delivery of an adequate amount of calories. Further complicating the issue is the exact definition of gastrointestinal intolerance and various feeding approaches that altogether determine the final amount of calories delivered to the critically ill patient. Finally, the issue of supplementing enteral nutrition with parenteral nutrition in patients who cannot be fed enterally or those who are fed but still develop large caloric deficits is still highly controversial. This review will explore the recent advances and key topics, along with available guidelines for feeding the critically ill patient. © 2012 SINPE-GASAPE.
Dawson D.,General Intensive Care Unit
Nursing in Critical Care | Year: 2014
Aim: This article aims to guide the nurse caring for a tracheostomy patient, following the main principles of nursing care. Background: Tracheostomy is a surgical procedure to create an opening in the anterior wall of the trachea. Owing to improvement in technological support, the number of adult patients receiving a tracheostomy has increased. This requires the critical care nurse to have an understanding of the essential principles of care for a patient with a tracheostomy tube in situ. Design and method: Literature search was conducted in Medline and Cinahl using the search terms tracheostomy OR tracheotomy AND procedure/nursing care/experience limited to English language and adult. Owing to the lack of empirical research on the care of patients with tracheostomy, evidence is limited and therefore expert consensus is utilized in much of the article. Results: This article considers the indications for a tracheostomy, identifies the component parts of a tracheostomy tube, discusses 12 essential principles of care for a patient with a tracheostomy tube in situ, and finally briefly describes the nurse's role in an emergency and when discharging a patient with a tracheostomy tube to a ward. Conclusion: Performing a tracheostomy has an enormous impact on patients and their care. Relevance to clinical practice: Nurses caring for patients with tracheostomy require an appreciation of the breadth of knowledge needed to provide individual and safe care. It is also important to appreciate the lack of empirical evidence on which to base that care. © 2014 British Association of Critical Care Nurses.
PubMed | General Intensive Care Unit
Type: Journal Article | Journal: Nursing in critical care | Year: 2014
This article aims to guide the nurse caring for a tracheostomy patient, following the main principles of nursing care.Tracheostomy is a surgical procedure to create an opening in the anterior wall of the trachea. Owing to improvement in technological support, the number of adult patients receiving a tracheostomy has increased. This requires the critical care nurse to have an understanding of the essential principles of care for a patient with a tracheostomy tube in situ.Literature search was conducted in Medline and Cinahl using the search terms tracheostomy OR tracheotomy AND procedure/nursing care/experience limited to English language and adult. Owing to the lack of empirical research on the care of patients with tracheostomy, evidence is limited and therefore expert consensus is utilized in much of the article.This article considers the indications for a tracheostomy, identifies the component parts of a tracheostomy tube, discusses 12 essential principles of care for a patient with a tracheostomy tube in situ, and finally briefly describes the nurses role in an emergency and when discharging a patient with a tracheostomy tube to a ward.Performing a tracheostomy has an enormous impact on patients and their care.Nurses caring for patients with tracheostomy require an appreciation of the breadth of knowledge needed to provide individual and safe care. It is also important to appreciate the lack of empirical evidence on which to base that care.