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Results for “Intensive Care Units”

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PubMedDate not supplied

Arterial blood-gas interpretations in the respiratory intensive-care unit.

The role of the nurse in the respiratory intensive-care unit requires increased sophistication as our knowledge of the patient becomes more complex. This expanded role should include a thorough understanding of disturbances in acid-base balance, the relationship of PaCO2 to ventilation, the difference in acute and chronic respiratory problems, and the causes and treatment of hypoxemia. The ability to analyze and evaluate blood-gas determinations is simply one more important tool the nurse may utilize in the care and treatment of the critically ill patient.

Acid-Base Imbalance↗

PubMed1977

[Admission and treatment of 592 patients over 70 years in an intensive care unit].

Using an IBM 3741 computer, the authors analysed 592 case records of patients aged over 70 years, admitted to hospital on an intensive care unit, age appears to be an important factor in determining the prognosis of numerous diseases without, however, being a criteria for rejection of admission of these patients to an intensive care unit. The fragility of these patients leads one to consider the following parameters: 1--the degree of resuscitation is assessed by quantification of the therapeutic means. As for other patients, survival varies inversely in relation to the important of the therapeutic means, but in the case of the elderly patient, there is a definite difference in the correlation mortality-therapeutic index towards aggravation, so one may determine a ceiling above which survival is not possible; 2--duration of the intensive care is very important. In most cases, the decisive point is situated on the 3rd or 4th day of care, at which time the decision to continue or stop treatment may be considered in the light of the patient's progress.

Aged↗

PubMed2025

Implementing customized genomic sequencing reports to empower providers in safety-net neonatal intensive care units.

PURPOSE: Through our implementation study providing rapid genomic sequencing (rGS) in safety-net neonatal intensive care units (NICUs), we investigated the feasibility and perceived usefulness of customized "clinical interpretive reports" (CIRs) to help neonatal providers with interpreting, disclosing, and managing care based on rGS results. METHODS: Enrolled infants received rGS through a clinically accredited vendor. We developed 5 CIR types to provide customized interpretation of rGS results and link results to clinical management considerations, research opportunities, and resources. We developed workflows to triage, create, and deliver CIRs within 3 business days. Providers received the vendor reports and CIRs, disclosed results, and completed post-disclosure surveys. We analyzed summary statistics for the first 100 cases. RESULTS: We delivered 97 of 100 CIRs (97%) within our goal time frame (average 1.3 days) and provided clinical management recommendations in 40 of 100 (40%). Neonatal providers completed the post-disclosure surveys for 86 of 100 disclosures (86%). Most reported using the CIR before disclosure (80/86, 93%) and found it helpful at providing useful information beyond the vendor report (79/80, 99%). CONCLUSION: It is feasible and useful to develop customized rGS reports to assist non-genetics providers in safety-net NICU settings. Similar approaches may hold promise for equitably advancing genomic care in non-NICU settings.

Humans↗

PubMed1979

A newly designed flexible fiberoptic bronchoscope for use in intensive care units.

A newly designed flexible fibroptic bronchoscope has been manufactured for use in intensive care units (ICU). It has an inside channel of large caliber, diameter 2.5 mm, through which pulmonary secretions can be aspirated directly via the suction tube. Furthermore, prompt bedside use is possible since handle type batteries can easily be attached to the bronchofibroscope. This new instrument is now employed in our ICU for: 1. The diagnosis and treatment of atelectasis. 2. Suction of retained secretions. 3. Detection of tracheal obstruction. 4. Evaluation of endotracheal and tracheostomy tubes whilst in position. 5. Observation of tracheal and bronchial changes. 6. Help in endotracheal intubation. It was used most frequently for the diagnosis and treatment of atelectasis and suction of retained secretions.

Bronchoscopes↗

PubMed1977

Outbreak of meningitis in a newborn intensive care unit caused by a single Escherichia coli K1 serotype.

Three cases of meningitis that occurred during a nine-day period in a newborn intensive care unit were caused by a single E. coli serotype 07:K1:H-. A single organism outbreak was suspected when the three spinal fluid isolates all possessed the same two unusual bacteriologic and biochemical characteristics: nonmotile and ornithine negative. Culture surveillance identified eight infants colonized with the same strain of E. coli; three of these infants are described. Clusters of cases of E. coli meningitis in newborn intensive care units should be evaluated and managed as potential outbreaks.

Cross Infection↗

PubMed1978

Otitis media in the neonatal intensive care unit.

Thirty-eight of 125 premature infants who were hospitalized in a neonatal intensive care unit (NICU) had abnormal tympanic membrane mobility compatible with otitis media. Twenty-five of these 38 had received antibiotics within one week of otoscopic examination and were considered to have either serous otitis or partially treated bacterial otitis media; tympanocentesis was not performed in them. Tympanocentesis was performed in the remaining 13 infants who had not received antibiotics. Bacterial otitis media was confirmed in ten of the 13. Either staphylococcal (six cases) or Gram-negative enteric organisms (four cases) were isolated in cultures obtained by tympanocentesis in these cases. The four cases of Gram-negative infections occurred in infants within six weeks of birth. Nasotracheal intubation for more than seven days was significantly correlated with impaired tympanic membrane mobility compatible with otitis media. Otitis media occurs frequently among premature infants who are hospitalized in an NICU, and it should be looked for in any infant in whom sepsis is clinically suspected.

Cross Infection↗

PubMed1979

Behavioral assessment for pediatric intensive care units.

Two studies were conducted to analyze behaviors of staff and patients on a Pediatric Intensive Care Unit (PICU). In the first study, behavioral observation procedures were employed to assess patient state, physical position, affect, verbal behaviors, visual attention and activity engagement, and staff verbal behavior. On the average, one-third of the patients were judged to be conscious and alert but markedly nonengaged with their environment. In the second study, a member of the hospital staff provided alert patients with individual activities to determine whether a simple environmental manipulation could positively affect behavior of children in intensive care. Employing a reversal design, the activity intervention was found to increase attention and engagement and positive affect, and to decrease inappropriate behavior. Both studies demonstrate that behavioral assessment procedures can provide an empirical basis for designing PICU routines affecting children's psychosocial status, and, thus, complement current procedures designed to provide quality medical care.

Adolescent↗

PubMed2026

Clinical impact of metagenomic next-generation sequencing for pathogen identification and guided therapy in pediatric intensive care unit patients with severe pulmonary infections.

UNLABELLED: To explore the diagnostic efficiency, clinical concordance, and precision treatment value of metagenomic next-generation sequencing (mNGS) for severe pulmonary infections in children in the pediatric intensive care unit (PICU), and to provide evidence for improving microbiological diagnosis and optimizing anti-infective strategies. A retrospective cohort study included 89 children with severe pneumonia in the PICU in 2024. All underwent routine microbiological testing and mNGS of bronchoalveolar lavage fluid (BALF). Detection rates, pathogen composition, co-infection identification, diagnostic concordance, and treatment impact were analyzed. Metagenomic next-generation sequencing demonstrated high diagnostic sensitivity in the PICU setting, achieving a positive detection rate of 90.0% (80/89) and identifying a diverse spectrum of 103 pathogens, including 50.5% viruses, 43.7% bacteria, 38.8% co-infections (vs 11.6%), and 86.3% diagnostic concordance (vs 55.8%, P < 0.01). Among 46 patients included in the therapeutic outcome analysis (22 in the mNGS-guided group), 21 patients in the mNGS-guided group improved. Multivariate logistic regression analysis, adjusting for confounding factors (age, underlying diseases, PaO2/FiO2 ratio, PRISM III score, and preoperative antibiotic use duration), confirmed that mNGS-guided therapy was an independent protective factor for achieving the primary outcome (OR = 5.23, 95% CI: 1.87-14.61, P = 0.002) and secondary outcomes (C-reactive protein reduction ≥50%: OR = 4.89, 95% CI: 1.72-13.93, P = 0.003; oxygenation improvement: OR = 5.67, 95% CI: 1.98-16.21, P = 0.001). Metagenomic next-generation sequencing demonstrated high diagnostic sensitivity in the PICU setting, guiding precision therapy, and improving prognosis. IMPORTANCE: It supports metagenomic next-generation sequencing (mNGS) as a supplementary tool for pediatric intensive care unit (PICU) refractory infections, guides anti-infective adjustments, and informs tiered diagnostic pathways for resource-limited settings to optimize cost-effectiveness.

Humans↗

PubMed1979

Nurses' stress factors in the intensive care unit.

To identify the origins to stress as preceived by ICU nurses, stressful situations in the intensive care unit were identified and ICU nurses were asked to rank order them. Situations pertaining to the physical workload, death of a patient, and communication problems with physicians and nursing administrators were ranked most highly stressful. Nursing educators and nursing administrators can make changes and adjustments to lessen these stressors.

Attitude to Death↗

PubMed1977

[An epidemic caused by serratia marcescens in an intensive-care unit for premature and other newborns (author's transl)].

An epidemic caused by Serratia marcescens occurred in intensive care unit of the Children's clinic in Essen, with three deaths. Although there was good sensitivity of the strain to gentamicin in vitro, there was no noticeable clinical improvement when it was administered. But cotrimoxazole, given systemically and locally, and colistin locally cured the disease.

Colistin↗

PubMedDate not supplied

The risks of umbilical vessel catheterization in a neonatal intensive care unit.

Five hundred and fourteen high-risk neonates who had indwelling umbilical catheters at the neonatal intensive care unit of the University of Benin Teaching Hospital were studied. of these 514 neonates, 122 (23.8%) had their catheters in-situ for longer than 24 h. Of the 122, fifty-four (44%) had positive bacterial cultures from their catheter tips. Seven (5.7%) and four (3.2%) of the 122 neonates studied developed septicaemia and necrotizing enterocolitis respectively. Catheterization for periods in excess of 48 h significantly increased the risk of bacterial colonization. Malposition of umbilical catheter tips include: insertion into the right portal vein (thirty-six cases); superior mesenteric vein (three cases) and the left atrium (four cases). The complications related specifically to the malposition were: air collection in the hepatic venous system (two cases); cardiac arrest (one case); necrotising enterocolitis (one case) and a case of blanching of the abdominal wall. Because of these complications, the indications for catheterization should be restricted to carefully selected patients and strict aseptic technique be adhered to during the procedure.

Catheterization↗

PubMed1979

Aetiology, diagnosis, treatment and prognosis of acute renal failure in an intensive care unit.

Over a period of 2 years, 82 patients out of 2,390 (3.43%) admitted to an intensive care unit developed acute renal failure (ARF). The diagnosis of ARF was based on the usual criteria of oliguria, a rising blood urea nitrogen and creatinine, urine sodium concentration greater than 20 mmol/l and a U/P osmolality ratio less than 1.1. In 9.2% of patients the latter two criteria were misleading. Sepsis was the commonest cause of vasomotor nephropathy but in 20.7% potentially nephrotoxic agents had been administered before development of ARF. Overall mortality was 73.2%, with patients older than 50 years of age having the highest mortality. ARF is associated with prolonged bed occupancy--an average of 59.8 days for the dialysed patients with ARF versus an average length of stay of 8.4 days for the hospital overall.

Acute Kidney Injury↗

PubMed1979

Parent care in the intensive care unit.

Explore the source record for details and available documents.

Child↗

PubMed1976

Hazards of the intensive care unit.

Complications arise in the introduction, maintenance, and use of devices for life support and monitoring in an intensive care unit. Since recognition of such complications is frequently difficult in this clinical setting, the radiologist is often in a position to be the first to detect complications associated with the use of endotracheal and tracheostomy tubes, Swan-Ganz catheters, subclavian catheters, central venous pressure catheters, and intra-aortic balloons.

Cardiac Catheterization↗

PubMed1979

[Influence of the use of a video device for monitoring and visits on psychologic relations between patients, families and medical staff in an intensive care unit (author's transl)].

The use of a video device for monitoring and familial visits in a medical intensive care unit has various effects on psychologic relations between the patient, his family and the medical staff. Such a device is used since 1972 in Lille and has concerned more than 10,000 patients. On one hand, the monitoring of the patient is facilitated. His dependence to the staff is enhanced and allows a better taking of responsibility from the nurses and a good adhesion to the cares. At last, the video device gives to the patient and his family a real feeling of security during the early phase of the hospitalization. On the other hand, and particularly after this early phase, the use of a video device has deleterious effects on the psychologic relations of the patient with his family: enhancement of the psychologic regression, creation of an additional agression which jeopardizes the restoration of normal relations after attempt of suicide or prolonged artificial ventilation. This underlines the need for a real psychologic management of the video device in the reception of the families and the frequency of the relations with the medical staff.

Adult↗

PubMedDate not supplied

Pedi-pack transfusion in a newborn intensive care unit.

Two hundred and ninety-one transfusions using 221 pediatric frozen red blood cell packs (Pedi-Packs) were given to 141 newborn babies and infants in the newborn intensive care unit. In 18 patients, 47 transfusions were studied for transfusion and clinical characteristics. Two possible hemolytic episodes are described in detail and remain unexplained. Blood loss for laboratory tests was found to average 3.1 ml/kg per day spent in the newborn intensive care unit. The rise in hematocrit was found to be excellent. Overall, the transfusion of thawed pediatric red blood cell packs was found to be convenient, safe and effective. Because of pretesting possibilities with the use of this source of red blood cells, one of the problems associated with a walking donor program is eliminated.

Anemia↗

PubMedDate not supplied

A survey of infection in an intensive care unit. "Forewarned is forearmed".

The infection (36%) and mortality rates (28%) were investigated in 433 patients admitted to a Respiratory Intensive Care Unit. It was found that the mortality rate was higher (45%) in the infected group than in the non-infected group (19%) and particularly so in patients who had had intra-abdominal surgery or who remained in the unit for longer than a week.

Abdomen↗

PubMed1979

[A retrospective study of the impressions and psychic reactions experienced by patients in a traumatological intensive care unit (author's transl)].

30 persons who had been treated for an average of 22 days on a traumatological intensive care unit were asked to comment on their impressions and experiences. 80% of the patients had been in need of artificial respiration; but this had not unduly distressed them and they remembered it only vaguely. The major worry in 30% of the cases was awareness of their condition and the fear of permanent physical and mental disablement. 25% had greatly suffered from thirst. There was no mention that finding themselves in an intensive care ward, being dependent on a respirator or monitoring equipment or being disorientated had caused distress. None of them had seriously contemplated the possibility of his own death. The frequent visits by relatives were regarded as great comfort and help towards achieving mental equilibrium. All these critically ill persons were highly impressed by the constant and dedicated medical and nursing care they had received.

Anxiety↗