Search results for "critical care and intensive care medicine"

Building a continuous multicenter infection surveillance system in the intensive care unit: findings from the initial data set of 9,493 patients from…

2008

OBJECTIVE: To describe the epidemiology of infections in intensive care units (ICUs), whether present at admission or acquired during the stay. METHODS: Prospective data collection lasting 6 months in 71 Italian adult ICUs. Patients were screened for infections and risk factors at ICU admission and daily during their stay. MAIN RESULTS: Out of 9,493 consecutive patients admitted to the 71 ICUs, 11.6% had a community-acquired infection, 7.4% a hospital-acquired infection, and 11.4% an ICU-acquired infection. The risk curve of acquiring infection in the ICU was higher in patients who entered without infection than in those already infected (log-rank test, p < .0001; at 15 days, 44.0% vs. 34.6…

Manejo de los anticoagulantes orales de acción directa en el período perioperatorio y técnicas invasivas

2012

The new direct-acting oral anticoagulants (ACOD) in patients on prolonged treatment require the need to balance the risk of haemorrhage by administering them against the risk of thrombosis on withdrawing them. Recommendations for their management are proposed in the present article: A) Thromboprophylaxis and general anaesthesia: the performing of regional anaesthesia if administered with an ACOD as thromboprophylaxis requires some safety intervals based on their pharmacokinetic parameters; B) Management of ACOD in elective surgery: in patients with normal renal function and a low haemorrhage/thrombosis risk, stop the ACOD two days before the surgery; it the haemorrhage/thrombosis risk is hi…

Disaster management in hospitals

1998

A disaster situation for a hospital occurs when the need for medical treatment overwhelms the actual hospital treatment capacity. 1 This may be defined by numerical or situational means; the threshold must always be the result of an individual assessment of the given health care unit. A disaster situation may also be defined as the point of no return to normal standard operating procedures in a certain hospital. In case of a disaster, health care units are required to have and activate a disaster management plan (DMP). In the USA the requirements of the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) are trend-setting; in European countries, regulations are normall…

Nasal pressure swings as the measure of inspiratory effort in spontaneously breathing patients with de novo acute respiratory failure.

2022

Abstract Background Excessive inspiratory effort could translate into self-inflicted lung injury, thus worsening clinical outcomes of spontaneously breathing patients with acute respiratory failure (ARF). Although esophageal manometry is a reliable method to estimate the magnitude of inspiratory effort, procedural issues significantly limit its use in daily clinical practice. The aim of this study is to describe the correlation between esophageal pressure swings (ΔPes) and nasal (ΔPnos) as a potential measure of inspiratory effort in spontaneously breathing patients with de novo ARF. Methods From January 1, 2021, to September 1, 2021, 61 consecutive patients with ARF (83.6% related to COVID…

A Fatal Bloodstream Infection byStaphylococcus pettenkoferiin an Intensive Care Unit Patient

2011

Coagulase negative staphylococci are increasingly recognized as leading pathogens in bacteremia, with incidence peaking in intensive care units. Interpretation of blood cultures that are positive for CoNS is often doubtful. We describe a fatal case of bacteremia by a newly recognized species of CoNS,Staphylococcus pettenkoferi, in an ICU patient.

Neuroprotective properties of xenon and helium in an in vitro model of traumatic brain injury: one small step or one big jump?

2008

Treatments for intracranial hypertension in acute brain-injured patients: grading, timing, and association with outcome. Data from the SYNAPSE-ICU st…

2023

Purpose: Uncertainties remain about the safety and efficacy of therapies for managing intracranial hypertension in acute brain injured (ABI) patients. This study aims to describe the therapeutical approaches used in ABI, with/without intracranial pressure (ICP) monitoring, among different pathologies and across different countries, and their association with six months mortality and neurological outcome. Methods: A preplanned subanalysis of the SYNAPSE-ICU study, a multicentre, prospective, international, observational cohort study, describing the ICP treatment, graded according to Therapy Intensity Level (TIL) scale, in patients with ABI during the first week of intensive care unit (ICU) a…

Alteration of anion gap during almost total plasma replacement with synthetic colloids in piglets

2000

In ten piglets (body weight 8.2-11.6 kg), acid base, electrolyte and anion gap changes were investigated during almost total plasma replacement with hydroxyethyl starch (HES) and modified fluid gelatin (GEL) in saline solution using a cell saver autotransfusion technique. During the study, there were only moderate acid base changes, but marked disturbances in anion balance. At study end, the mean chloride concentration was significantly higher (mmol/l: normal values 97-108, HES 116 +/- 1.5, GEL 108 +/- 1.1, p0.01) and the mean anion gap was significantly lower in the HES group in comparison to the GEL group (mmol/l: normal values 5-14, HES 3 +/- 1.7, GEL 11.9 +/- 0.9, p0.01). It is conclude…

Anaphylaktoide Reaktion auf ein nichtionisches Röntgenkontrastmittel in Allgemeinanästhesie

1990

The occurrence of adverse reactions is decreasing since the introduction of non-ionic contrast media. Anaphylactoid reactions during general anaesthesia are rare and hitherto only documented with the administration of ionic compounds. We report an episode of hypotension, tachycardia, bronchospasm and urticaria following application of a non-ionic contrast medium (Iopamidol) during isoflurane anaesthesia. We conclude that a combinent use of anaesthesia and non-ionic contrast media does not guaranty protection from anaphylactoid reactions to iodinated radiopaque compounds.

Ventricular paired pacing to control intractable junctional tachycardia following open heart surgery in a child.

1989

A 5-month-old girl presented postoperatively with an atrioventricular (A-V) junctional tachycardia at a rate of 245/min following surgical repair of tetralogy of Fallot. The systolic blood pressure dropped to 60 mmHg with this rapid heart rate, and the infant became shocked. Drugs and overdrive pacing were ineffective in suppressing the A-V junctional tachycardia and in improving cardiac output. Ventricular paired pacing was used successfully to halve the mechanically effective ventricular rate and to restore cardiac output. When ventricular paired pacing was stopped after 12 h, the spontaneous rhythm was an atrial rhythm with 1-1 A-V conduction. The patient was discharged in sinus rhythm o…