A tale of two intensive care units? All intensive care units are not the same!
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Intensive Care Units↗
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[Patient flow at a medical intensive care unit].
Intensive care units have been established in all somatic hospitals in Norway over the last two decades. In order to examine the use of these units in a medical department the group of patients admitted to the unit at Haukeland hospital during a six month period was analyzed. The flow of patients is twice that found in the regular medical wards. The dominating reason for admittance is heart disease. The overall mortality of the patients in these units is high. However, it is probable that it may be possible to define groups of patients, who without reduction of medical security, could be treated in regular and less costly medical wards.
Humans↗
An assessment of the criteria for selection of patients for an obstetric intensive care unit.
Intensive care monitoring of the fetus during labour improves perinatal conditions in 'high-risk" Black women. If the available facilities and staff are to be used with maximal efficiency, a system of priorities is necessary. It would appear that patients with meconium staining of the liquor, with cephalopelvic disproportion, or with two or more indications for monitoring, should have priority for admission to our intensive care unit. Hypertension and antepartum haemorrhage are of less importance, but there are two other problems which need investigation. There is a group of patients in labour who arrive too late to be monitored. They have a considerable perinatal mortality and the reasons for their late arrival need to be ascertained. There is a second group of patients who begin labour before term and deliver babies with a high risk of perinatal death. These problems require further investigation.
Arrhythmias, Cardiac↗
[Responsibility of the surgeon in intensive care units].
Intensive care facilities in most hospitals are concentrated in one or more specialised units. There are different forms of organisation. The leadership of the surgeon or the anesthesiologist is common in operative intensive care. However, operative intensive care is an interdisciplinary task, and the surgeon is responsible for all problems connected to or resulting from the operation.
Critical Care↗
[Tasks and organization of a pediatric intensive care unit].
Paediatric intensive care medicine mainly involves infants during the neonatal period and, in particular, premature babies. 70% of the children on assisted ventilation at the paediatric hospital of Graz University in 1985 and 1986 were neonates. Older children needing mechanical ventilation comprised only 1.6% of the total number of patients at our paediatric hospital. Paediatric intensive care units are therefore almost exclusively neonatal care units. Otherwise when serving the needs of children beyond the neonatal period these units are mostly required by paediatric subspecialities (i.e. cardiology, burns unit etc.). In view of the small number of patients in this group a high-standard paediatric intensive care unit should be multidisciplinary and preferentially attached to a university hospital rather than a regional hospital so as to maximise experience in the management of these children and ensure optimal care.
Austria↗
Outbreak of multiply resistant Staphylococcus aureus in a pediatric intensive care unit after consolidation with a surgical intensive care unit.
Patients in a pediatric intensive care unit were placed with patients in an adult surgical intensive care unit (SICU) in a large, 12-bed room previously occupied exclusively by the adult patients. The occurrence of multiply resistant Staphylococcus aureus (MRSA) in pediatric patients increased from zero cases during the preceding 12 months to seven cases (p less than 0.001) for the 95 days that the units were combined. The rate of acquisition of MRSA by the patients in the SICU remained unchanged. Pediatric patients who acquired MRSA had longer lengths of stay (p less than 0.001) and underwent more surgical (p less than 0.01) and invasive procedures than did pediatric patients who did not acquire MRSA. Removal of the pediatric patients to their own unit returned their rate of MRSA acquisition to the previous low level.
Adult↗
Validation of a severity of illness score (APACHE II) in a surgical intensive care unit.
The intensive care unit is an important resource for the treatment of patients needing medical and surgical care for complicated diseases. The diversity of diseases and the difference in arrangements between hospitals providing such care have limited the precision of evaluations of intensive care. We have measured the admission characteristics and hospital mortality of 598 consecutive patients admitted to our Surgical Intensive Care Unit (SICU) using a severity of disease classification system (APACHE II) on the first day of admission. Hospital outcome details were available on 87% of the SICU patients. The overall mortality was 21.7%, mean APACHE score for survivors and non-survivors was 14.2 and 22.4, and their risk of death was 21.1% and 54.1%. The APACHE II scoring system provided an excellent means of classification, with a higher sensitivity and specificity.
Female↗
Bacteriologic contamination of intravenous infusion delivery systems in an intensive care unit.
Seventy intensive care unit patients were admitted to a double-blind prospective study to determine the level of contamination associated with the admixture and administration of intravenous solutions and whether intravenous filtersets prevented bacteremia. Patients were randomly assigned a 0.22 micron filterset (real filter) or a filter cartridge without a 0.22 micron membrane (blank filter) on all possible intravenous lines. Forty-six (14.1 percent) real filtersets and 38 (11.3 percent) blank filtersets were found to be contaminated, and overall 30 patients (42.4 percent) were found to have extrinsically contaminated intravenous administration systems at least once during the study. Bacterial adherence to the plastic cartridge was demonstrated to be responsible for culture-positive blank filtersets. Staphylococcus epidermidis was the organism most frequently isolated from real and blank filtersets. Epidemiologic surveillance identified 10 patients with blank filtersets and three patients with real filtersets with clinically significant hospital-acquired bacteremias during the study period. It is concluded that a significant level of extrinsic contamination of intravenous infusion delivery systems occurred on the intensive care unit; documented clinically significant nosocomial bacteremias occurred less often in those patients who had a 0.22 micron bacterial retention filter on all possible intravenous lines.
Bacteriological Techniques↗
Value of a secretomic approach for distinguishing patients with COVID-19 viral pneumonia among patients with respiratory distress admitted to intensive care unit.
In intensive care units, COVID-19 viral pneumonia patients (VPP) present symptoms similar to those of other patients with Nonviral infection (NV-ICU). To better manage VPP, it is therefore interesting to better understand the molecular pathophysiology of viral pneumonia and to search for biomarkers that may clarify the diagnosis. The secretome being a set of proteins secreted by cells in response to stimuli represents an opportunity to discover new biomarkers. The objective of this study is to identify the secretomic signatures of VPP with those of NV-ICU. Plasma samples and clinical data from NV-ICU (n = 104), VPP (n = 30) or healthy donors (HD, n = 20) were collected at Nantes Hospital (France) upon admission. Samples were enriched for the low-abundant proteins and analyzed using nontarget mass spectrometry. Specifically deregulated proteins (DEP) in VPP versus NV-ICU were selected. Combinations of 2 to 4 DEPs were established. The differences in secretome profiles of the VPP and NV-ICU groups were highlighted. Forty-one DEPs were specifically identified in VPP compared to NV-ICU. We describe five of the best combinations of 3 proteins (complement component C9, Ficolin-3, Galectin-3-binding protein, Fibrinogen alpha, gamma and beta chain, Proteoglycan 4, Coagulation factor IX and Cdc42 effector protein 4) that show a characteristic receptor function curve with an area under the curve of 95.0%. This study identifies five combinations of candidate biomarkers in VPP compared to NV-ICU that may help distinguish the underlying causal molecular alterations.
Humans↗
[Noise in an intensive care unit].
An Intensive Care Unit is noisy. These Noises are made by the Machines and the Staff. Nose must be limited and also the patient isolated.
Equipment and Supplies, Hospital↗
Anti-infective therapy in intensive care units.
In intensive care units, treatment is primarily directed at the suspected pathogen. However, the risk of interaction with other concomitantly administered drugs, the possible accumulation when renal and, in particular, hepatic function are impaired, and the possible development of resistance play major roles when selecting a therapeutic regimen. Studies of interactions between the different antimicrobial substances and, in particular, interactions between the antibiotics and other drugs are urgently called for in the future.
Anti-Infective Agents↗
Airway colonization by Flavobacterium in an intensive care unit.
A total of 195 patients admitted to a respiratory-surgical intensive care unit became colonized with species of Flavobacterium during a 70-month prospective study. By biochemical, cultural, and morphological criteria and a comparison of antibiotic susceptibilities, all patient isolates of Flavobacterium were apparently related. The origin of these organisms was sought. Flavobacterium were recovered from different water-associated areas of the hospital and from the hands of respiratory-surgical intensive care care unit staff. The organisms were also found in university dormitory sinks. The isolation of these organisms from tap water led to their recovery from reservoirs supplying drinking water to the city of Boston and surrounding communities. These organisms are resistant to chlorine concentrations found in municipal water. There was no proven case of pneumonia caused by Flavobacterium in 2,329 consecutive patients studied in our respiratory-surgical intensive care unit.
Air Microbiology↗
Importance of radiant flux in the treatment of hyperbilirubinemia: failure of overhead phototherapy units in intensive care units.
Prior to 1972, radiation used to treat neonatal hyperbilirubinemia was based upon the photometric unit, the foot-candle, a measure of light illumination. Measurements in terms of microwatts per square centimeter for selective wavelengths is more precise. We compared the effectiveness of phototherapy provided by overhead phototherapy units in intensive care modules vs. conventional phototherapy units. Forty-two infants were studied over a six-month period and divided into three groups based upon radiant flux measurements as follows: Group 1 (No. = 6), 1.0 muw to 1.9 muw/sq cm/nm; group 2 (No. = 15), 2.0 muw to 3.9 muw/sq cm/nm; group 3 (No. = 21), 4.0 muw to 6.0 muw/sq cm/nm. All flux determinations were made within the 400- to 500-nm range. All infants in group 1 were treated with overhead phototherapy units in the intensive care modules. Because of multiple factors known to increase the risk of kernicterus, evaluation of effectiveness of phototherapy at low radiant flux was limited in group 1. Significant changes in bilirubin were noted by 48 hours when comparing group 3 with groups 1 and 2. A minimum of 4.0 muw/sq cm/nm appears necessary for effective phototherapy. As designed, phototherapy units in intensive care modules are ineffective in delivering this therapeutic level of radiant flux.
Humans↗
Prevention of pneumonia in an intensive care unit: a randomized multicenter clinical trial. Intensive Care Unit Group of Infection Control.
In a randomized multicenter clinical trial on antibiotic prophylaxis, 1,319 patients in 23 ICUs were enrolled over a 4-month period. The end-point of the study was the prevention of early onset pneumonia (EOP), defined as acquired pneumonia diagnosed within 4 days of ICU admission; this accounted for greater than 50% of overall pneumonia. Patients eligible for the study were divided into three groups which received either cefoxitin (2 g iv for three doses/8 h), penicillin G (2 million U iv for four doses/6 h), or no antibiotic (control group). In the overall population, the incidence of EOP was 6.1% in the prophylaxis recipients vs. 7.2% in the control group (a 15.3% reduction). No statistically different rates of pneumonia or death were found among the groups. Patients with impaired reflexes on admission or prolonged ventilatory support were noted to have a lower incidence of EOP and an improved outcome when treated with cefoxitin.
Adolescent↗
Can a clinician predict the technical equipment a patient will need during intensive care unit treatment? An approach to standardize and redesign the intensive care unit workstation.
The technical equipment of today's intensive care unit (ICU) workstation has been characterized by a gradual, incremental accumulation of individual devices, whose presence is dictated by patient needs. These devices usually present differently designed controls, operate under different alarm philosophies, and cannot communicate with each other. By contrast, ICU workstations could be equipped permanently and in a standardized manner with electronically linked modules if the attending physicians could reliably predict, at the time of admission, the patient's equipment needs. Over a period of 3 1/2 months, the doctors working in our 20-bed surgical ICU made 1,000 predictions concerning outcome, equipment need, duration of artificial ventilation, and duration of hospitalization for 300 recently admitted patients. The interviews were made within the first 24 hours after admission. The doctors being interviewed were usually (i.e., in over 90% of cases) unfamiliar with the patient. Information concerning the patient's general state of health, special pre-ICU events, and complications was offered to the interviewed clinician because this information represents standard admission data. It was found that the equipment need (represented by two different setups, "high tech" and "low tech") could be predicted most reliably (96.4% correct predictions) compared with a prediction on outcome of ICU treatment (94.5%), on duration of artificial ventilation (75.4%), and on duration of stay (43.4%). There was no significant (p greater than 0.05) difference in the reliability of predictions between residents and consultants. Factors influencing the postoperative equipment need varied with surgical specialty.(ABSTRACT TRUNCATED AT 250 WORDS)
Anesthesia Department, Hospital↗
Effects of the nursing mutual participation model of care on parental stress in the pediatric intensive care unit.
The pediatric intensive care unit (PICU) hospitalization of a child is stressful for parents. Helping parents to decrease their stress is warranted so that they can function in the vital role that is therapeutic to them and their critically ill child. Many parent-supportive nursing interventions have been recommended but none has been tested in the clinical setting. A quasi-experimental design was used to study the effects of the nursing mutual participation model of care (NMPMC) on the perceived environmental stress of parents in the PICU. Thirty-three parents, experiencing the PICU for the first time, participated in the study. Sequential sampling divided the participants into two groups, control and experimental. The experimental group participated in the NMPMC, designed to be supportive to and guided by the perceived individual needs of each parent. The dependent measure was the Parental Stressor Scale: Pediatric Intensive Care Unit administered within 24 to 48 hours of PICU admission, every 48 hours thereafter, and 24 hours after PICU discharge. The results indicate that the NMPMC is helpful in alleviating parental stress, specifically the stress related to interruption in the parent-child relationship, in the PICU setting.
Child↗
[The role of respiratory physiotherapy in an intensive care unit].
In an intensive care unit an important role is assigned to respiratory physiotherapy. Its principal task is efficacious toilet of the bronchi by fluidifying the secretions, promoting their ungluing from the respiratory tree and facilitating their evacuation by cough or by aspiration with a catheter or bronchoscope. The technique comprises the inhalation of a secretolytic (e.g. Bisolvon, NaCl 9%) and, in the case of asthma, bronchospasmolytic (e.g. Ventoline) aerosol followed by breathing exercises. The other objectives of physiotherapy are to ensure a better distribution of inspired air, increase failing ventilation, ameliorate disturbed gas exchange, relax the contracted respiratory muscles and prevent bronchiolar collapse in emphysema during expiration. The field of application of respiratory physiotherapy is large; its purpose is prophylactic and therapeutic. The method is prophylactic in all patients confined to bed, where there is a risk of bronchial obstruction or ventilatory failure, especially in those with severe operation, traumatism or consciousness disorder. Physiotherapy has a therapeutic role in several, principally broncho-pulmonary diseases, such as asthma, obstructive emphysema, pneumonia, bronchiectasis, pulmonary abscess, atelectasis, and pulmonary and pleural fibrosis. Myocardial infarction and pulmonary embolism in the acute state, acute pulmonary edema, pneumothorax and pulmonary hemorrhage are contraindications for physiotherapy. If the method is to be effective the intensive care unit should have a specialized physiotherapist attached to it working there on a daily basis.
Bronchodilator Agents↗
Intrapartum maternal and fetal monitoring: the obstetric intensive care unit.
The Obstetric Intensive Care Unit (OBICU) at Bellevue Hospital in New York City has adapted intensive care and coronary care models to the care of patients in labor. During the past 3 years, 519 of the most serious of 2 250 high-risk obstetric patients treated at the hospital were monitored in the OBICU. There were two maternal and six perinatal deaths. The perinatal mortality rate of the very high risk population of the OBICU was 11.6/1 000, compared to 14.7/1 000 for all deliveries performed at the hospital. Our findings indicate that the OBICU system provides the ideal mechanism for the rapid and continuous control of symptoms in very high risk gravidas which is essential for stabilizing the patient, both for prompt delivery and for optimal maternal and fetal survival.
Adolescent↗