JOURNAL OF RENAL CARE, Issue 2 2009
Sofia Zyga
SUMMARY Patients who are treated in an intensive care unit (ICU) show the need of recovery of their renal function. The reason is that, in this particular cohort of patients, we have to maintain the necessary balance between body fluids, electrolytes, and acid-base, try to suspend further renal damage and purify the patient's blood to better accept the given therapy. In this paper, we try to demonstrate all the methods that can be used depending on the patient's condition, the therapist's preferences and the hospital's capabilities. [source]

The Use of B-Type Natriuretic Peptides in the Intensive Care Unit

CONGESTIVE HEART FAILURE, Issue 2008
Christian Mueller MD
B-type natriuretic peptide levels are quantitative markers of cardiac stress and heart failure that summarize the extent of systolic and diastolic left ventricular dysfunction, valvular dysfunction, and right ventricular dysfunction. Initial observational pilot studies have addressed 7 potential indications in the intensive care unit: identification of cardiac dysfunction, diagnosis of hypoxic respiratory failure, risk stratification in severe sepsis and septic shock, evaluation of patients with shock, estimation of invasive measurements, weaning from mechanical ventilation, as well as perioperative and postoperative risk prediction. Although additional studies are required to better define the clinical utility of B-type natriuretic peptide values in the intensive care unit, current data suggest that the diagnosis of hypoxic respiratory failure and timing of extubation seem to be the most promising indications. Congest Heart Fail. 2008;14(4 suppl 1):43,45. ©2008 Le Jacq [source]

Adenosine infusion attenuates soluble RAGE in endotoxin-induced inflammation in human volunteers

ACTA PHYSIOLOGICA, Issue 1 2009
A. Soop
Abstract Aim:, To evaluate possible anti-inflammatory effects of pre-treatment with adenosine in a human experimental inflammatory model. Methods:, The study design was double-blind, crossover, placebo-controlled and randomized. In the Intensive Care Unit of a university hospital, 16 healthy male volunteers were treated for 5.5 h with infusions of adenosine 40 ,g kg,1 min,1 or placebo. Thirty minutes after the start of adenosine or placebo, 2 ng kg,1E-Coli endotoxin was administered. Heart rate, body temperature, blood pressure, plasma cytokines (TNF-,, IL-6 and IL-10), soluble RAGE and resistin, exhaled nitric oxide and nitrite/nitrate in urine were determined. Results:, Endotoxin elicited the expected clinical signs of an inflammatory reaction (tachycardia, fever) and led to prominent release of the cytokines studied (P < 0.001). Resistin in plasma increased after endotoxin (P < 0.001). After placebo treatment, soluble RAGE (sRAGE) in plasma increased 5 h after the endotoxin challenge (P < 0.001) but not after adenosine. After placebo, orally exhaled NO increased with a peak at 4 h (P < 0.001), although there was no statistically significant difference between the two treatments. Nitrite/nitrate in urine (n = 11) did not differ between adenosine and placebo treatments. Conclusion:, In conclusion, adenosine infusion starting before endotoxin challenge in humans attenuated sRAGE significantly but otherwise had no clear anti-inflammatory effect. Adenosine as a potential anti-inflammatory treatment in humans needs further study, including use of higher doses. The mechanism underlying the effect of adenosines on sRAGE remains unknown. [source]

Childhood leukaemia: experiences of children and attitudes of parents on dental care

EUROPEAN JOURNAL OF CANCER CARE, Issue 3 2008
Ç.E. ÇUBUKÇU phd
Parental perceptions in the importance of dental care and preferences with regard to its provision while profiling the level of dental health knowledge of parents of leukaemic children were elicited. The setting was the Paediatric Dental Care Unit located in Medical Faculty. Data were collected by means of a structured interview, employing a questionnaire. Level of knowledge on both dental facts and preventive dentistry of the participants was insufficient. Major source of dental care was the resident paediatric dentist both in prior to (78.2%) and following (100%) diagnosis. Tooth extraction (17.6%) was the only treatment provided prior to diagnosis. Following diagnosis, 60 (69%) of these children had received operative dental treatment. The source of preventive advice was inconsistent. Parents appeared to place a high level of importance on their children's dental care and the preference for this to be provided within the hospitals in which the child has been treated. There is clearly a need to establish dental care units in hospitals in which treatment of childhood malignancy is provided. The provision for the future should be the continuous education of dentists, physicians and nurses who work in hospitals and public health services. [source]

Student perspectives and opinions on their experience at an undergraduate outreach dental teaching centre at Cardiff: a 5-year study

EUROPEAN JOURNAL OF DENTAL EDUCATION, Issue 1 2010
C. D. Lynch
Abstract Aim:, Outreach teaching is now regarded as a desirable component of undergraduate dental teaching programmes in the UK. A purpose-built undergraduate dental outreach-training centre was opened in Cardiff in 2002. The aim of this paper is to report student perspectives and opinions on their experience at this unit over a 5-year period. Methods:, Final year dental students at Cardiff University were invited to report their comments on the St David's Primary Care Unit at various times during their placement there. Information was recorded for undergraduate students who commenced final year in 2003, 2004, 2005, 2006 and 2007 (n = 257). Results:, After 1 year, the most common favourable aspects reported by students included the availability of a suitably trained nurse for all procedures (n = 191), ready access to helpful/approachable teaching staff (n = 145), and closeness of learning experience to subsequent practice (n = 122). Many students commented on their growing confidence in their own abilities whilst in the unit. Conclusion:, Overwhelmingly, students reported their enthusiasm for training in an outreach teaching unit, preferring it to traditional dental school environments. Inherent in the comments recorded for each student was a sense of growing confidence in their abilities and development of reflective practice. Further work is needed to identify the impact of this form of dental student training on subsequent practices in Vocational Training and independent clinical careers. [source]

Altered pharmacology in the intensive care unit patient

FUNDAMENTAL & CLINICAL PHARMACOLOGY, Issue 5 2008
Giovanni Zagli
Abstract Critically ill patients, not infrequently present alterations of physiological parameters that determine the success/failure of therapeutic interventions as well as the final outcome. Sepsis and polytrauma are two of the most common and complex syndromes occurring in Intensive Care Unit (ICU) and affect drug absorption, disposition, metabolism and elimination. Pharmacological management of ICU patients requires consideration of the unique pharmacokinetics associated with these clinical conditions and the likely occurrence of drug interaction. Rational adjustment in drug choice and dosing contributes to the appropriateness of treatment of those patients. [source]

Anxiety affects the relationship between parents and their very low birth weight infants

INFANT MENTAL HEALTH JOURNAL, Issue 3 2007
Phyllis Zelkowitz
The goal of this study was to examine the medical and sociodemographic factors associated with parental anxiety following the birth of a very low birth weight infant (VLBW, below 1500 g), and to determine the impact of anxiety on the behavior of parents with their VLBW infants in the Neonatal Intensive Care Unit (NICU). The parents of 88 VLBW infants were recruited through the NICU of a tertiary-care hospital, approximately 2 weeks following delivery. Parents completed self-report questionnaires measuring anxiety, marital quality, and social support. Prior to discharge, each parent was observed twice during a feeding interaction with the infant. Maternal anxiety was greater when their infants were smaller in terms of birth weight and younger in gestational age. Maternal education, marital status, and country of origin, as well as social support and marital quality, were also associated with anxiety. Paternal anxiety was not related to socioeconomic status or infant medical risk, but was associated with country of origin, social support, and marital quality. For both mothers and fathers, anxiety was a better predictor of parental behavior than was infant medical risk. These findings suggest the need to intervene with anxious parents in order to promote satisfactory parent-infant relationships. [source]

An audit of the use of granulocyte colony-stimulating factor in septic shock

INTERNAL MEDICINE JOURNAL, Issue 4 2002
D. P. Stephens
Abstract Background:,Granulocyte colony-stimulating factor (G-CSF) stimulates the production of neutrophils and modulates the function and activity of developing and mature neutrophils. In septic shock, the immune system can be considered one of the failing organ systems.G-CSF improves immune function and may be a useful adjunctive therapy in patients with septic shock. Aim:,To evaluate the introduction of G-CSF as an adjunct to our standard treatment for community-acquired septic shock. Methods:,We performed a prospective data collection and analysis to determine whether the addition of G-CSF to our standard treatment for community-acquired septic shock was associated with improved hospital outcome, compared with an historical cohort ofsimilar patients. We included all patients admitted to the Intensive Care Unit (ICU) with community-acquired septic shock between December 1998 and March 2000. Patients received 300 µg G-CSF intravenously daily for 10 days in addition to ourstandard treatment for community-acquired septic shock. G-CSF was discontinued early if the patient was discharged from ICU before10 days or if the absolute neutrophil count exceeded 75 × 106/mL. Results:,A total of 36 patients with community-acquired septic shock, an average Apache 2 score of 26.7, and a predictedmortality of 0.79, were treated with G-CSF from December 1998 to March 2000. Hospital mortality was 31% compared with an historical cohort of 11 similar patients with a hospital mortality of 73% (P = 0.018). In the subgroup of patients with melioidosis septic shock, the hospital survival improved from 5% to 100% (P < 0.0001). No significant adverse events occurred as a result of the administration of G-CSF. Conclusion:,G-CSF is a safe adjunctive therapy in community-acquired septic shock and may be associated with improved outcome. The use of G-CSF in septic shock should undergo further investigation to define subgroups of patients who may benefit from G-CSF. The use of G-CSF in patients with septic shock due to Burkholderia pseudomallei is recommended. (Intern Med J 2002; 32: 143,148) [source]

Special acute care unit for older adults with Alzheimer's disease

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 2 2008
Maria E. Soto
Abstract Objective To describe the cognitive, functional, and nutritional features of patients admitted to a Special Acute Care Unit (SACU) for elderly patients with Alzheimer's disease (AD). Methods One-year observational study of patients with AD and other related disorders hospitalized in the SACU, Department of Geriatrics, Toulouse university Hospital during 2005. A comprehensive neurocognitive and non-cognitive geriatric assessment was performed. Data on full clinical evaluation, nutritional status, activities of daily living (ADL), gait and balance disturbance, behavioural and psychological symptoms (BPSD), and sociodemographics were recorded. Results Four-hundred and ninety-two patients were assessed. Their mean age was 81.1,±,7.7, the mean length of stay was 10.7,±,6.3 days, 62% were female, 63.9% were admitted from their own home and 30.4% from a nursing home. Eighty percent of patients had probable Alzheimer's disease or mixed dementia, less than 20% had other causes of dementia. Results of their comprehensive assessment showed a mean mini-mental state examination of 14.5,±,7.4; a mean total ADL score of 3.7,±,1.7. Seventy-seven percent had gait or balance disturbances; 90% of patients presented an unsatisfactory nutritional status. The most common reason for admission was BPSD. Conclusion AD complications are responsible for many acute admissions. Elderly patients suffering from dementia represent a population with unique clinical characteristics. Further randomised clinical trials are needed to evaluate the effectiveness of Special Acute Care Units for patients with AD and other related disorders. Copyright © 2007 John Wiley & Sons, Ltd. [source]

Nursing Diagnoses in a Brazilian Intensive Care Unit

INTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 3 2006
Amália De Fátima Lucena
PURPOSE.,To identify the nursing diagnoses and their most frequent related factors or risk factors in patients admitted to an intensive care unit (ICU). METHOD.,Descriptive cross-sectional study with information from 991 admissions to an ICU during a 6-month period. FINDINGS.,Sixteen nursing diagnoses resulting from hospitalization were most frequently identified; six had percentages greater than 40% with 29 related/risk factors. The resulting averages were 6.9 diagnoses per hospitalization and 1.2 related/risk factors per nursing diagnoses. CONCLUSIONS.,The nursing diagnoses identified seemed to be common to the clinical practice of nursing and their fundamental related/risk factors to precise clinical judgment, thus providing a basis for interventions for a desired outcome. PRACTICE IMPLICATIONS.,The findings have contributed to the development of the standardized nursing language usage in Brazilian nursing practices. Diagnósticos de Enfermagem em uma Unidade de Terapia Intensiva Brasileira OBJETIVO.,Identificar os diagnósticos de enfermagem e os seus fatores relacionados/risco mais freqüentemente estabelecidos aos pacientes internados numa unidade de terapia intensiva (UTI). MÉTODO.,Estudo descritivo, transversal, com informações de 991 admissões numa UTI, durante seis meses. RESULTADOS.,Dezesseis diagnósticos de enfermagem foram mais freqüentes, seis deles com percentuais acima de 40% por internação e com 29 fatores relacionados ou de risco. As médias foram de 6,9 diagnósticos de enfermagem por internação e 1,2 fatores relacionados ou de risco por diagnóstico de enfermagem. CONCLUSÕES.,Os diagnósticos de enfermagem identificados parecem ser comuns à prática clínica de enfermagem e os seus fatores relacionados ou de risco fundamentais ao julgamento clínico preciso, que subsidia à escolha da intervenção para um resultado esperado. IMPLICAÇÕES PARA A PRÁTICA.,Os resultados têm colaborado para o desenvolvimento do uso da linguagem padronizada de enfermagem no Brasil. [source]

Content Validation of Parental Role Conflict in the Neonatal Intensive Care Unit

INTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 1 2006
Elenice Valentim Carmona MN
PURPOSE.,To validate the content of the nursing diagnosis parental role conflict made by neonatal intensive care (NICU) nurses and researchers in the field and to identify the related major and minor defining characteristics. METHOD.,Fehring's Diagnostic Content Validation model using 59 neonatal specialists. FINDINGS.,Nineteen defining characteristics were validated for use in NICUs: four were considered major and 15 as minor. There was no correlation between nurse profiles and defining characteristic scores. CONCLUSIONS.,In this study, parental role conflict was validated for use in neonatal units but defining characteristics must be described in a clearer and more objective manner. NURSING IMPLICATIONS.,Validation studies in different healthcare settings are required so that the specificities of each clientele are met. NANDA diagnoses must be tested and validated at neonatal units, because this setting has developed few studies and their use in practice is a potential way to improve nursing care. [source]

Nursing Diagnoses Identified During Parent Group Meetings in a Neonatal Intensive Care Unit

INTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 3-4 2005
Ianê Nogueira Do Vale RN
PURPOSE.,To identify nursing diagnoses in the reports of parents obtained during parent support group meetings in a neonatal intensive care unit. METHODS.,An explorative descriptive study using records obtained during 29 meetings over a period of 11 months with parents and family members. FINDINGS.,Six NANDA-approved nursing diagnoses were identified from parent group data: fear, risk for impaired parent/infant attachment, parental role conflict, risk for ineffective breastfeeding, impaired home maintenance, and risk for caregiver role strain. Diagnoses were not validated with parents. DISCUSSION.,Support groups helped the parents express their thoughts and feelings and provided nurses with opportunities to identify nursing diagnoses and interventions. The identification of nursing diagnoses showed that nursing interventions that are focused on improved parent outcomes should be implemented for parents and other family members. IMPLICATIONS.,Nursing care in neonatal units should focus on interventions for parents and other family members in addition to providing the necessary care of newborns. [source]

Advancing Patient Safety through Process Improvements

JOURNAL FOR HEALTHCARE QUALITY, Issue 5 2009
Linda Elgart
Abstract: The department of Women's and Children's Services at the Hospital of Saint Raphael (HSR) in New Haven, CT, has initiated several different and successful approaches to reducing patient risk within the department. The department purchased a computerized fetal monitoring and documentation program that has improved the ability to provide high-level antepartal care for mothers and fetuses with automatic patient data management and continuous fetal heart rate surveillance. A Risk Reduction Grant offered through the hospital malpractice insurance program provided the financial assistance for all medical providers to become certified in electronic fetal monitoring. The certification is now a required educational standard for nurses, certified nurse midwives, and for physicians who work in the labor and delivery unit. Infant and pediatric security is incorporated into policy and practice measures that include hospital-wide drills for the prevention of infant abduction. The Obstetrics and Gynecology (OB/GYN) Quality Improvement Committee supports systematic reviews of identified clinical risks and works to find viable solutions to these problems. The hospital has supported specialized obstetrical care through the Maternal Fetal Medicine Unit (MFMU), Newborn Intensive Care Unit (NICU), the Inpatient Pediatric Unit, and the labor and delivery unit. In addition, HSR has initiated an enhanced medical informed consent that is available online for providers and a patient education tool that includes a computer room at the hospital for patient use. [source]

Posttraumatic Stress Symptoms in the Pediatric Intensive Care Unit

JOURNAL FOR SPECIALISTS IN PEDIATRIC NURSING, Issue 2 2007
Wendy Ward-Begnoche
PURPOSE.,Children who experience acute injury or illness severe enough to result in a pediatric intensive care unit (PICU) stay are at risk for posttraumatic stress symptoms, as are their parents. A distinction is made between injury-related traumatic events, illness-related traumatic events, and treatment-related traumatic events, all of which contribute to this risk. CONCLUSIONS.,This paper reviews what the PICU experience is like for children and their parents, the emerging literature on posttraumatic stress symptoms in PICU patients and their parents, and current knowledge regarding risk and resiliency factors for these children. PRACTICE IMPLICATIONS.,Children hospitalized in the PICU should be monitored for posttraumatic stress disorder during and after their stay. Risk and resiliency factors are a focus for practice and for future research. [source]

Hyperglycemia as a Predictor of In-Hospital Mortality in Elderly Patients without Diabetes Mellitus Admitted to a Sub-Intensive Care Unit

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 6 2008
Intissar Sleiman MD
OBJECTIVES: To investigate the association between hyperglycemia and in-hospital and 45-day mortality in acutely ill elderly patients. DESIGN: Retrospective cohort. SETTING: Hospital medical patients admitted to a sub-intensive care unit (sub-ICU) for elderly patients, which is a level of care between ordinary wards and intensive care. PARTICIPANTS: One thousand two hundred twenty-nine patients (mean age 79.6±8.4) admitted to the sub-ICU from January 2003 to January 2006. Forty patients with acute myocardial infarction and 34 patients with extreme fasting glucose values (<60 or >500 mg/dL) were excluded. Eight hundred twenty-two patients without a history of diabetes mellitus (DM) and 333 patients with a diagnosis of DM were selected and subdivided into three categories according to serum fasting blood glucose: 60 to 126 mg/dL (Group A), 127 to 180 mg/dL (Group B), and 181 to 500 mg/dL (Group C). MEASUREMENTS: Age, sex, mental and functional status, Acute Physiology Score, comorbid conditions, serum albumin, serum cholesterol, fasting serum glucose, and length of stay. In-hospital mortality was the primary outcome, and 45-day mortality was the secondary outcome. RESULTS: Total in-hospital mortality was 14.5%. In patients with and without DM, mortality was 8.8% and 11.3%, respectively, in Group A; 13.6% and 17.3% in Group B, and 12.6% and 34.3% in Group C. After controlling for confounders, newly recognized hyperglycemia (>181 mg/dL) was independently associated with in-hospital mortality (adjusted odds ratio=2.7, 95% confidence interval=1.6,4.8). Forty-five-day mortality in newly recognized hyperglycemic patients was 17.5%, 25.7%, and 42% in Groups A, B, and C, respectively, whereas it was 21.2% in patients with DM. CONCLUSION: In elderly patients, newly recognized hyperglycemia was associated with a higher mortality rate than in those with a prior history of DM. These data suggest that further randomized clinical trials are needed to assess the efficacy and the risk of a target glucose of greater than 180 mg/dL. [source]

The effect of total plasma exchange on fulminant hepatic failure

JOURNAL OF CLINICAL APHERESIS, Issue 2 2006
M. Akdogan
Total plasma exchange (TPE) corrects coagulopathy in patients with liver disease and removes hepatotoxins/cytokines. This improvement is transient but can be used as a bridge until an organ is identified for liver transplantation (LTx) or the liver itself regenerates. Our aim was to retrospectively assess the efficacy of TPE in fulminant hepatic failure (FHF) and its impact on liver function tests. Between 1995,2001, 39 patients with FHF who had undergone TPE were reviewed. FHF was defined according to the O'Grady criteria based on the duration of encephalopathy as well as jaundice. TPE was performed using the Cobe Spectra TPE (Gambro®) in Liver Intensive Care Unit, continued on a daily basis, until either adequate clinical response was achieved, the patient expired, or transplantation occurred. INR, PTT, Fibrinogen, ALT, AST, GGT, BUN, Ammonia, and Total Bilirubin were analyzed before and after TPE. Student's t -test and chi-square test and ANOVA were used for statistical analysis. Thirty-nine patients with FHF (31 females, 8 males with mean age of 32.3, range: 7,64) underwent TPE. Coagulopathy, hyperbilirubinemia, hyperammonemia were significantly improved (P < 0.05). Twenty-one patients survived (54%), 12 required LTx, and 18 patients (including one after LTx) expired. TPE was found to be significantly effective for correction of coagulopathy and improvement of liver tests. This intervention can be considered for temporary liver support until recovery or liver transplantation. J Clin Apheresis 2005. © 2005 Wiley-Liss, Inc. [source]

Febrile Ulceronecrotic Mucha-habermann Disease: a Rare, Severe Variant

JOURNAL OF CUTANEOUS PATHOLOGY, Issue 1 2006
Michele M. Thompson
A 56 year old Hispanic man presented with extensive ulcerative skin lesions, involving his lower trunk, groin and upper legs, severe pain and a temperature of 38.7 degrees Celsius. He was admitted to the Medical Intensive Care Unit for empiric intravenous antibiotics. Several biopsies were performed. In the following days his condition worsened and ulcerative lesions involved nearly all of his skin. Previous biopsies were consistent with pityriasis lichenoides et varioliformis acuta (PLEVA), however, neither this, nor others in the histological differential diagnosis, fit his severe and worsening clinical picture. Histology revealed vacuolar alteration with dyskeratotic keratinocytes and a superficial perivascular mixed infiltrate of lymphocytes and eosinophils. There was confluent parakeratosis containing neutrophils, and a diminished granular layer with pallor in the upper portion of the spinous layer. Immunofluorescence studies were negative. These findings were consistent with PLEVA. A clinical diagnosis of febrile ulceronecrotic Mucha-Habermann disease was made. Febrile ulceronecrotic Mucha-Habermann disease is a rare and severe variant of PLEVA characterised by high fever and papulonecrotic skin lesions. Twenty-five cases have been previously reported. We present the clinical and histological findings in this unusual clinical presentation. [source]

Home alone: Assessing mobility independence before discharge,,§¶

JOURNAL OF HOSPITAL MEDICINE, Issue 4 2009
Dennis M. Manning MD, FACC
Abstract Hospitalists are often confronted with discharge planning responsibility and decisions for elderly patients who live alone. The absence of an in-home helper (spouse, partner, or care-giver) reduces the margin of safety and resilience to any new debility. Research has documented that during hospital stays elderly patients tend to become deconditioned, even if there is no new specific neurologic or motor deficit. In the patient whose pre-hospital mobility independence is not robust, and perhaps marginally compensated, inpatient stays for any diagnosis may result in critical decrements in mobility independence. The present study is an effort to design a bedside tool for the hospitalist by which to discern, or screen, for such debility. The tool is a hierarchical performance test we named I-MOVE (Independent Mobility Validation Examination). It is a quick series of bedside mobility requests to demonstrate capability of fundamental movements critical to independent living. We describe manner in which I-MOVE can be performed. Moreover, we describe the face validity and the high interrater reliability (> 0.90 intra-class correlation coefficient) of two RNs who independently administered and scored I-MOVE for 41 patients on a General Medical Care Unit. Although not yet studied in correlation with outcomes, nor with validated mobility assessment tools, we believe I-MOVE can serve as a useful extension of the nurse's assessment, or the Hospitalist's physical examination. Discerning the continued capability of mobility independence is a desirable, on-going insight for discharge planning of the elderly patient who resides alone. Journal of Hospital Medicine 2009;4:252,254. © 2009 Society of Hospital Medicine. [source]

Iatrogenic Forearm Compartment Syndrome in a Cardiac Intensive Care Unit Induced by Brachial Artery Puncture and Acute Anticoagulation

JOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 2 2002
M.H.A, SHAY SHABAT M.D.
A previously healthy patient developed late compartment syndrome in the cardiac intensive care unit after a brachial artery puncture due to acute heparinization after successful percutaneous transluminal coronary angioplasty (PTCA) and stent implantation. The cardiologists recognized the problem and immediately consulted an orthopedic surgeon, who promptly performed surgery. The latter consisted of decompression and fasciotomy. The patient recovered excellent hand function without any neurologic or muscular deficits. Knowledge and understanding of the clinical aspects of this complication are crucial in this devastating syndrome. [source]

Two outbreaks of Burkholderia cepacia nosocomial infection in a neonatal intensive care unit

JOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 1-2 2008
Jimmy KF Lee
Background: An outbreak of Burkholderia cepacia septicaemia occurred in our neonatal unit over a 9-week period in 2001, affecting 23 babies and two died. A second outbreak lasting 8 days occurred a year later, affecting five babies. Setting: Neonatal Intensive Care Unit, Kuala Terengganu Hospital. Aim: To review the patient characteristics and the risk factors for septicaemia in the first outbreak. Methods: Retrospective review of records and in the first outbreak a case,control analysis with 23 matched controls for risk factors for septicaemia. Results: In the first outbreak, median birthweight was 1670 g (range 860,3760) and median gestational age was 32 weeks (range 27,41). There were 32 episodes of septicaemia, and five and two patients had two and three episodes, respectively. The mortality rate was 6.3% per septicaemic episode. Multiple logistic regression showed the presence of a prior long line was associated with first septicaemic episode (OR 7.07, 95% CI 1.37,36.47 with P = 0.019) but not prior assisted ventilation. The organism was isolated from the water of an oxygen humidifier in the delivery room, three ventilator water traps and one humidifier water trap in the neonatal unit. In the second outbreak, six episodes of septicaemia occurred in five neonates with median birthweight 2060 g and median gestational age 32.5 weeks. The organism was isolated from two ventilator water traps. Conclusion: These two outbreaks of Burkholderia cepacia subsided with general infection control measures. The sources of these two outbreaks were not identified. [source]

Serious injuries from dishwasher powder ingestions in small children

JOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 3 2006
Amy Bertinelli
Aims: To describe patterns and severity of caustic injuries sustained from dishwasher powder ingestion and highlight need for national safety standards. Methods: Retrospective chart review of admissions for caustic ingestion to Starship Children's Hospital from January 2003 to January 2005 and review of New Zealand National Poisons Centre data. Results: Between January 2003 and January 2005, the National Poisons Centre recorded 610 dishwashing powder ingestions, with 88% of children less than 2 years old. Twenty-three children were admitted to Starship Children's Hospital following caustic ingestion, of whom 11 were identified as having ingested dishwasher powder (9 boys and 2 girls) and were aged 11 to 30 months (mean 17.5). Five children (45%) were admitted to the Paediatric Intensive Care Unit over 4 months (October 2004 to January 2005), requiring intubation for airway control. Two children needed tracheostomy. Three of the 11 children (27%) required repeated oesophageal dilatation, and two underwent gastrostomy formation. One brand of dishwasher detergent and container type was implicated in over half of the cases. Conclusions: Dishwasher detergents are highly corrosive substances that cause potentially life-threatening injuries and ongoing morbidity. The recent surge of incidents may be related to change in product constituents or non-compliance with New Zealand safety standards. Efforts to limit product alkalinity, legislative requirement of Child-Resistant Packaging and public education may reduce injuries from these common household substances. [source]

Clinical significance of polymicrobial bacteremia in newborns

JOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 7 2005
Piyush Gupta
Objective: To identify whether polymicrobial bacteremia in newborns is associated with any predisposing factors, distinguishing clinical features, or higher mortality. Methods: Results of blood cultures obtained over a period of 1 year from neonates admitted to the paediatric ward and Neonatal Intensive Care Unit of a tertiary care hospital were retrospectively analysed. The study group included all cases with polymicrobial bacteremia (isolation of two or more organisms). Controls (double the number of study cases) were randomly selected from the monomicrobial group. Case records of included cases were retrieved and scrutinized. Results: Of 770 positive cultures during the study period, 52 (6.8%) cultures were positive for more than one organism. Complete case records were retrieved for 40 polymicrobial and 78 monomicrobial cases. The two groups were comparable for maternal and neonatal parameters including: maternal and obstetric complications; period of gestation; mode of delivery; birthweight and perinatal asphyxia; clinical symptomatology; invasive therapeutic interventions; and mortality. Conclusions: Isolation of more than one organism from the blood culture of a suspected septic newborn is not rare. It does not always represent a true invasion by multiple organisms. Polymicrobial isolation per se should not be the criterion for hastily changing the therapeutic decisions. [source]

The Role of Acinetobacter baumannii as a Nosocomial Pathogen for Dogs and Cats in an Intensive Care Unit

JOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 2 2000
Thierry Francey
Acinetobacter baumannii is a nosocomial pathogen associated with high morbidity and mortality in humans. Whereas infections with strains of Acinetobacter species have been reported in various situations, the importance of A baumannii as a nosocomial pathogen in veterinary hospitals has not been studied so far. In this retrospective case series, we describe 17 dogs and 2 cats from which A baumannii had been isolated during a 21/2-year period. In 7 dogs, A baumannii induced systemic signs of illness, whereas 12 animals showed signs of local infection. In all animals with systemic infection, and in 2 with localized infection, A baumannii contributed to the death of the animal or contributed to euthanasia; the remaining 8 dogs and both cats recovered. Molecular typing of the isolates with restriction polymorphisms of ribosomal DNA provided evidence of nosocomial spread of this pathogen and for the presence of several strains of A baumannii in the hospital environment. [source]

Neuromuscular Electrical Stimulation As a Possible Means to Prevent Muscle Tissue Wasting in Artificially Ventilated and Sedated Patients in the Intensive Care Unit: A Pilot Study

NEUROMODULATION, Issue 4 2010
Raf L.J. Meesen PhD
Objective:, The aim of this study was to explore if electrical stimulation could prevent muscle atrophy. Material and Methods:, Patients were hospitalized for postoperative coronary artery bypass graftin, chronic obstructive pulmonary disease, ventilatory failure, or acute cerebro-vascular accident, and were divided into an intervention group or a control group. The intervention group underwent daily 30 minute training with an intermittent neuromuscular electrical stimulation applied to the right quadriceps muscle. Heart rate, respiration rate, systolic and diastolic blood pressure, and oxygen saturation were monitored before, during, and after electrical stimulation. Circumference of both thighs was measured. Results:, The intervention resulted in a significant reduction of muscle atrophy in the stimulated as compared with the non-stimulated limb (p < 0.05), without making any impact on cardiovascular, respiratory and, hemodynamic characteristics. Conclusions:, Muscle atrophy is prevented by intermittent neuromuscular electrical stimulation while this intervention showed no obvious impact on the cardio-respiratory conditions of the patients. [source]

Observing the approaches to weaning of the long-term ventilated patients

NURSING IN CRITICAL CARE, Issue 2 2010
Kalliopi Kydonaki
Background: The weaning process from mechanical ventilation is a complicated issue for patients with respiratory failure who require long-term respiratory support. Although the application of weaning protocols reduces weaning time, and enhances patient outcome, little is known about the actual approaches that clinicians use for the weaning of these patients. Aim: The purpose of this paper is to explore approaches to weaning of long-term ventilated patients in a Scottish Intensive Care Unit. The findings are part of a larger study on decision-making during the weaning of long-term ventilated patients. Method: Data were collected through participant observation and follow-up interviews with the nursing staff. Twenty-four-hour chart and medical notes review and informal conversation with the bedside nurse were also used to collect information on the weaning process. Findings: Nine patients were recruited to the study. Two patients were extubated and three patients were extubated but then required a tracheostomy. A further four patients had a tracheostomy performed. Thematic analysis of the data showed that weaning was individualized, and physician led, regardless of the existence of the weaning protocol. Six different weaning approaches were identified. Nurses followed a conservative approach to weaning in comparison to doctors who appeared more aggressive. Conclusion: There are many varieties in the approaches clinicians use when weaning long-term ventilated patients, which acts on the continuity of their care. A shift of focus to identify ways of maintaining continuity of care and a combined ,wake and wean' approach needs to be considered. [source]

Developing and setting up a patient and relatives intensive care support group

NURSING IN CRITICAL CARE, Issue 1 2009
Maureen Peskett
Abstract Aim:, The purpose of this article was to highlight the need to provide support for patients and relatives following critical illness and discharge from hospital and how this can be improved through the establishment of user support groups. Background:, Critical illness predisposes patients to extended physical and psychological ill health with the potential for a reduced quality of life. The authors' personal experience, patient feedback and current literature suggested that there was a need for further support during their recovery. Methods:, Building on an existing formal follow-up service, Intensive Care Unit (ICU) Support Team for Ex-Patients established a patient-centred forum, where patients and relatives could share experiences with others who had also been through critical illness by holding drop-in sessions. Feedback from those attending these flexible and informal sessions indicates that support was needed and that patients and families have found benefit in sharing experiences with others who can empathise, having been through critical illness themselves. Conclusions:, Our experience has shown there is a need that can be met simply with minimal investment of time and funding but that addresses a gap in patient support that otherwise goes unmet. Although this was a service development in one local area, it could be adapted to ICU patients and relatives more widely. [source]

Immediate follow-up after ICU discharge: establishment of a service and initial experiences

NURSING IN CRITICAL CARE, Issue 2 2003
Eunice Strahan
Summary ,Follow-up of patients discharged from the intensive care unit (ICU) is recommended as a means of service evaluation (Department of Health (2000). Comprehensive Critical Care: a Review of Adult Critical Care Services), in order to monitor the quality of the services provided ,Without patient follow-up, ICU staff have only ,death' or ,discharge alive from hospital' as clinical outcomes from which to judge practice performance, and limited evidence exists on which to base decisions about improvements to critical care practice (Audit Commission (1999). Critical to Success , the Place of Efficient and Effective Critical Care Services Within the Acute Hospital ) ,To address these issues the Regional Intensive Care Unit (RICU) obtained information from patient assessment/interview on problems experienced by patients within 8,9 days (mean), following discharge from RICU ,A nurse-administered questionnaire was used to identify functional outcomes, nutrition and psychological issues such as anxiety and sleep disturbances ,Benefits of patient follow-up introduced and planned include: ,patient diaries for long-term patients ,input from clinical psychologist ,review of sedation used in RICU [source]

Assessing levels of contaminants in breast milk: methodological issues and a framework for future research

PAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 1 2008
Mary J. Renfrew
Summary To assess the scale of the possible exposure by the breast-fed infant to potentially harmful substances in breast milk, methodologically robust studies are essential. Many studies in this field, however, do not report details of crucial issues such as recruitment and milk sampling. The aims of the study reported here were to develop robust methods for the study of contaminants in breast milk, and to develop a framework for future research and population monitoring. Three cohorts of women and babies were recruited by midwives from five sites in northern England. Cohort 1 (cross-sectional, n = 322) were asked to provide two milk samples, one at one week following birth and one at a subsequent time point. Cohort 2 (longitudinal, n = 54) were asked to provide five samples at specified time points over the first 12,16 weeks after birth. Cohort 3 (convenience, n = 18), mothers of babies in the Special Care Unit, were asked to donate surplus breast milk. A novel method of analysing fat concentration in small volumes was developed and tested. A randomly selected set of samples from different donors and stages of lactation was screened for organochlorine pesticide residues, polychlorinated biphenyls, dioxins/furans, phthalates and heavy metals. A total of 453 samples were donated. Cohort 3 was the least successful route of recruitment. Cohorts 1 and 2 combined were most representative of the population. Sample collection, transport and storage procedures, and the collection of data on life style and diet, were robust and acceptable to women. Midwifery involvement in recruitment was an essential component. This study offers a framework both for the conduct of future research studies, and for the establishment of regional and national monitoring mechanisms for contaminants in breast milk. Similar work on contaminants in formula as fed to babies is needed to inform risk assessment methods. [source]

Beau's Lines and Multiple Periungueal Pyogenic Granulomas After Long Stay in an Intensive Care Unit

PEDIATRIC DERMATOLOGY, Issue 2 2008
GUILLERMO GUHL M.D.
Immobilization, hypoxia, and drugs might have acted as potential causative factors. [source]

Plasma ADMA concentrations at birth and mechanical ventilation in preterm infants: A prospective pilot study

PEDIATRIC PULMONOLOGY, Issue 12 2008
Milan C. Richir MD
Abstract Rationale Nitric oxide (NO) produced in the lung is an important mediator of normal lung development, vascular smooth muscle relaxation, and ventilation perfusion matching. NO is synthesized from arginine by the action of NO-synthase (NOS). Asymmetric dimethylarginine (ADMA), an endogenous derivate of arginine, inhibits NOS and is thereby a determinant of NO synthesis. We compared ADMA and arginine levels in preterm infants requiring mechanical ventilation with preterm infants who did not require mechanical ventilation and determined the relation between ADMA and the length of mechanical ventilation in these infants. Methods Thirty preterm infants, mean (SD) gestational age 29.3 (1.7) weeks and birth weight 1,340 (350) gram, of the Neonatal Intensive Care Unit of the VU University Medical Center were included. ADMA and arginine were measured in umbilical cord blood and the length of mechanical ventilation (days) was registered. Results Gestational age and birth weight were significantly smaller in infants requiring mechanical ventilation, but were not significantly correlated with plasma ADMA concentration after birth. Plasma ADMA concentrations were significantly higher in infants who required mechanical ventilation than in infants who did not require mechanical ventilation (1.53,±,0.23 and 1.37,±,0.14 µmol/L, respectively; P,=,0.036). ADMA concentration was significantly related to length of mechanical ventilation (B,=,3.4; 95% CI: 1.1,5.6; P,=,0.006), also after adjustment for gestational age (B,=,2.3; 95% CI: 0.4,4.2; P,=,0.024). Conclusions Preterm infants who require mechanical ventilation have increased ADMA levels compared to non-ventilated preterm infants. ADMA levels at birth are related to the length of mechanical ventilation. An increased ADMA concentration could reduce NO synthesis, which could lead to insufficient gas exchange and, consequently, a longer period of mechanical ventilation. Pediatr. Pulmonol. 2008; 43:1161,1166. © 2008 Wiley-Liss, Inc. [source]