In the intensive care unit.
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Intensive Care Units↗
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[A case. Reflections on visits to children in intensive care units].
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Intensive Care Units↗
[Duties and problems of a neurological intensive care unit (author's transl)].
The duties and problems of a neurological intensive care unit are described and illustrated by our experience with a newly built intensive care unit. Indications, technical equipment, diagnostic, therapeutic, scientific, personnel and psychological aspects are pointed out and a first survey of the patients treated. An approximately equal group of seasonal acute inflammatory diseases of the central and peripheral nervous systems compares with a similar one with cerebral vascular processes. The possibility of longterm electrophysiological studies using computers and trend analysis and the particular significance of CSF pressure measurements and pharmacokinetics of the CSF as scientific aspects are emphasized.
Acute Disease↗
[Portable resuscitation complex for resuscitation wards and intensive care units].
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Equipment and Supplies, Hospital↗
Nursing staff stress in an intensive care unit.
The stresses associated with nursing in an intensive care unit were assessed. A comparison was drawn between a group of Black and a group of White nurses. Proposals aimed at reducing the observed stress patterns are suggested.
Black or African American↗
Mobile intensive care unit. Present conception and realisation.
A new Mobile Intensive Care Unit has been put in use at the "Service 900" of the Ministry of Health in Belgium. Its size was decided to enable efficient treatment of one patient. The type of suspension was chosen to give the patient adequate protection against untoward effects of travelling sickness. Radio-communication with the control center and hospital is ensured. The O2 supply-system provides an autonomy of 11 hours. Besides an electric distribution of 12 V. DC, a 220 V. AC is also available.
Ambulances↗
[Hospital infections with pseudomonas aeruginosa. II. Intensive care units (author's transl)].
72 newly admitted patients of three surgical intensive care units of the Medical School Hannover were examined bacteriologically for pseudomonas aeruginosa for a period of 7 months. A total of 810 specimens was examined during therapy. 95 strains of pseudomonas aeruginosa were isolated in 32 of 72 patients, taken either at the time of admission or during the stay of the patients in the hospital. The frequency of contamination increased with the duration of the stay of the patients in the hospital as follows: 20 per cent at the time of admission, 71 per cent after 8 to 10-day stay and up to 100 per cent for a duration of stay exceeding 14 days. The germs were mainly localized in the nose-throat region and in the respiratory tract. The results of phage typing suggested a hospital infection in about 50 per cent of the patients. The relationship between infection and infectious disease was discussed with respect to the epidemiologic characteristics of intensive care units. Furthermore, it was attempted to formulate recommendations for interrupting or abolishing the infection chains.
Cross Infection↗
[Interaction between intensive care patients; a comparison of different intensive care units (author's transl)].
A study was made of the extent and type of contact which patients of an intensive care unit established with each other. The information was obtained by interviewing 92 patients in 4 different types of intensive care units. In evaluating and interpreting the results special attention was paid to the possible influence of 10 patient-specific and disease-specific parameters. 81 per cent of the interviewed persons had established contact, mostly of a verbal nature, with their fellow patients. The majority appreciated the companionship and attached a positive value to the contacts made: communication with the other patients relieved the mental stress arising from their condition and detracted from their anxiety and tendency to brooding; on the other hand, they were also, to some extent, worried that too much excitement might adversely affect their condition. Encouraging talks by the medical team greatly helped towards reducing stress. Even severely ill persons who could no longer actively communicate felt happier in a multi-bed ward: they felt less isolated and more involved and therefore, psychically supported. The fact that the great majority of patients preferred multi-bed units to single rooms suggests that the former have a stabilizing effect, both physically and psychically - an aspect of intensive care that has so far been ignored.
Bed Occupancy↗
[Hematologic intensive care units for cancer patients. Their role in the efficacy of cytostatic chemotherapy].
Intensive care units for hematology or oncology patients consist of rooms free from pathogenic germs and low in microbe content. The units are staffed by doctors and nurses checked to be non carriers of pathogenic germs, and platelet and granulocyte transfusions are available. The first of these rooms, the Unit Fred-Siguier at the Hospital Paul-Brousse (Villejuif), was created for patients receiving bone marrow transplantation. Several units now exist in Europe. Results from two cooperative chemotherapy trials conducted at a European level showed that the number of remissions was double in services equipped with such rooms when compared with other hospital services. The study thus provides further evidence of the great need for such intensive care units.
Antineoplastic Agents↗
Bacterial contamination of telephones in an intensive care unit.
Pathogenic and potentially pathogenic bacteria were found on telephones of an intensive care unit. Direct contamination by microorganisms from throats, hands, and noses of the staff members is real although airborne contamination would also play a role. The awareness of environmental risk in intensive care units is underlined.
Asepsis↗
Respiratory infection in an intensive care unit.
A postmortem bacteriological study of Black children in a respiratory intensive care unit showed that Pseudomonas aeruginosa was the most common opportunistic pathogen and that it usually complicated a viral infection. In a parallel study of non-debilitated patients in general hospital wards Klebsiella aerogenes and Escherichia coli were the most frequently isolated organisms. Counter-immuno-electrophoresis was used for the identification of Pseudomonas-precipitating antibody in serum and tracheal secretions, and also of Pseudomonas antigen in the latter.
Antigens, Bacterial↗
Nurse turnover in the newborn intensive care unit.
Nurse retention has become a significant issue in the newborn intensive care units for two main reasons: 1) the quality of care declines as it is delivered by inexperienced nurses, and 2) the cost of orienting new nurses is exorbitant. "Stress" has been implicated as one of the important factors in nurse retention; it appears that a paradox exists in that the stress/excitement that attracts a nurse to the newborn ICU in the first place may ultimately drive her away. We attempted to define stress factors in the Turner Newborn Intensive Care Unit at Hermann Hospital in Houston, Texas, and to develop management methods to decrease stress. Over a three-year period, during the implementing of new programs, nurse termination rates decreased significantly, as did turnover.
Humans↗
Cardiopulmonary resuscitation: impact on hospital mortality--a ten-year study.
The effectiveness of cardiopulmonary resuscitation as a vital aspect of health care delivery in hospital was the basis for a ten-year study. All instances of cardiac arrest occurring outside the operating room and nursery were included. Variations in degrees of success of cardiopulmonary resuscitation as related to the duration of the program, differences among varying subsets such as patients' type of illness and hospital location (emergency room, coronary care unit, intensive care unit or nursing floor) at the time of cardiopulmonary arrest, are presented. The relationship between cardiopulmonary resuscitation frequency and success with increasing instrumentation is reviewed. A simple technique for expressing effect of cardiopulmonary resuscitation on hospital mortality is presented. The study shows the ability of a community hospital to establish, maintain and document a high level cardiopulmonary resuscitation program.
California↗
Aspergillus pneumonia--a cluster of four cases in an intensive care unit.
Four cases of Aspergillus pneumonia occurred in an intensive care unit within a short period. Clusters of cases of invasive aspergillosis are rare and have usually been attributed to excessive contamination of the environment. Extensive environmental studies were, however, negative. Three of the cases were diagnosed ante mortem. One patient survived after early initiation of treatment with amphotericin B.
Adult↗
[Hygienic problems in intensive care units (author's transl)].
Microbiological tests have established that intensive care units act as a reservoir from which hospital infections spread. The mode of their spread is reviewed. The increased incidence of nosocomial infections to intensive care wards is attributable partly to deficient antisepsis and asepsis and partly to inadequate planning of the building and organization of these wards. Plans for two intensive care wards are put forward which would reduce the risk of contact, smear and air-borne infections. In the planning of these units greater attention than has so far been the case should be paid to preventing the spread of pathogenic micro-organisms.
Air Microbiology↗
Length of survival after cardiac resuscitation in an intensive care unit.
Seventy-four patients were admitted after cardiac resuscitation to a general intensive care unit; 19, of whom 14 were neurologically normal, were utimately discharged from hospital. It is suggested that elderly patients, those who have had prolonged resuscitation, and patients with a combination of hypothermia, coma, dilated pupils, and apnoea have a very poor prognosis. It is doubtful whether such patients benefit from admission to an intensive care unit.
Acid-Base Imbalance↗
Colonization of intensive care unit patients with gram-negative bacilli.
A prospective study of 64 patients admitted to a medical intensive care unit and 86 patients admitted to a surgical intensive care unit was done to determine the frequency of pharyngeal, intestinal, and tube site colonization with Gram-negative bacilli. Studies were carried out over a 13-week period. The pharyngeal carrier rate among the surgical patients increased by a total of 34 strains compared to 14 strains among medical patients. Similarly, the intestinal carrier rate increased by 35 strains compared to 12 strains. The increased carriage in surgical patients was related more to the presence of indwelling tubes and colonization of multiple sites in the same patient than to the use of antimicrobial drugs. Pharyngeal and rectal colonization in medical patients was related to antibiotic therapy. Indwelling tubes were used predominately in surgical patients and were a significant reservoir of these organisms.
Anti-Bacterial Agents↗
[Serratia marcescens infection in intensive care units (author's transl)].
The increased incidence of Serratia marcescens infection at the intensive care unit of the Department of Anaesthetics, General Hospital Altona, was investigated. The properties of this microorganism are described and its role in cross infections is discussed. The frequent occurrence of Serratia marcescens in mixed infections and its tendency to grow on tissue surfaces are pointed out. The presence of Serratia marcescens was demonstrated in 23 of 107 patients treated in the intensive care unit; an infection with Serratia was established in 13 of the 23 cases. Four patients died. As vital functions were severely impaired in these cases death could not be attributed solely to the Serratia infection. Preventive and therapeutic measures are reviewed.
Adolescent↗