International Journal of Critical Care and Emergency Medicine最新文献

{"title":"What Statistics do Emergency Physicians Need to Know","authors":"A RamoskaEdward, P. Virat, Gragossian Alin, Nocera Romy","doi":"10.23937/2474-3674/1510068","DOIUrl":"https://doi.org/10.23937/2474-3674/1510068","url":null,"abstract":"","PeriodicalId":13937,"journal":{"name":"International Journal of Critical Care and Emergency Medicine","volume":"56 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83959367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of Programmed Multilevel Ventilation as a Superior Method for Lung Recruitment in Heart Surgery","authors":"C. Peter, Kolesar Adrian, N. Martin, P. Matus, Sabol Frantisek, D. Viera, Donic Viliam, Torok Pavol","doi":"10.23937/2474-3674/1510067","DOIUrl":"https://doi.org/10.23937/2474-3674/1510067","url":null,"abstract":"Objectives: During cardiac surgery, extracorporeal circulation (ECC) causes lung injury. In these inhomogenously affected lungs, the pressure control ventilation (PCV) cannot adequately ventilate differently damaged lung compartments. We invented and used original multilevel lung ventilation method named 3-LV based on alternating 3 or more pressure levels, ventilation frequencies and delivered tidal volumes. The goal of this article is to compare lung mechanics in cardiac surgery patient after ECC using standard PCV when compared to 3LV ventilation. Methods: This study was performed on 88 cardiac surgery patients after disconnection from ECC; the patients were randomly (allocation by weekdays) divided into two groups and ventilated by PCV and 3LV. Group 1 (n = 44) started with 1 hour PCV followed by a second hour with the 3-LV mode. Group 2 (n = 44) was ventilated in the reverse order. Measured parameters were statistically evaluated by the Student’s paired t-test. Results: The static compliance (Cst) and PaO2/FiO2 ratio in 3-LV ventilation mode improved by 25-32% (p < 0.01) and 31% (p < 0.01), in group actually ventilated by 3LV ventilation. The respiratory rate after weaning in Group 1 significantly decreased compared with that in Group 2 (p < 0.05). An improved CO2 washout was observed in each group after switching to 3LV. Conclusions: 3-LV showed a better lung recruitment ability compared with PCV in patients after cardiac surgery, without using high PEEP level.","PeriodicalId":13937,"journal":{"name":"International Journal of Critical Care and Emergency Medicine","volume":"111 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77744333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of Adverse Outcome Early After ICU Discharge","authors":"M. Katsiari, Kyriakos Ntorlis, C. Mathas, C. Nikolaou","doi":"10.23937/2474-3674/1510065","DOIUrl":"https://doi.org/10.23937/2474-3674/1510065","url":null,"abstract":"Objective: Clinicians are often confronted with the timely discharge decision, in order to avoid readmission and escalation of costs. Aim of the present study was to determine potential risk factors for ICU readmission or death early after ICU discharge. Methods: One hundred fifty-four ICU discharged patients were divided into three outcome groups according to whether they were readmitted (Group A, n = 13), or died within 72 h after ICU discharge (Group B, n = 11), or were not readmitted or died within 72 h (Group C, n = 130). Results: Patients being readmitted to the ICU had significantly longer prior length of stay in a ward compared to the group with positive outcome after ICU discharge (median: 12 vs. 2 days, p = 0.023). Patients with early post discharge death had received vasopressor support with norepinephrine for significantly longer period of time and were significantly more severely diseased at the day of discharge, based on APACHE II calculation. Rates of tracheostomy, central venous catheter, nasogastric nutrition and colonization with an MDR organism, along with hemodynamic and respiratory parameters at ICU discharge were similar among the outcome groups. Nonetheless, the prevalence of patients with Glasgow Coma Scale (GCS) < 13 was significantly higher in Group B. The principal cause of ICU readmission was sepsis (8/13 patients), whereas of early mortality was acute respiratory failure (9/11 patients). Conclusions: Patients with higher disease severity at discharge and moderately altered mental status, especially those with prolonged hospitalization and vasopressor support are at increased risk for ICU readmission or early post discharge mortality.","PeriodicalId":13937,"journal":{"name":"International Journal of Critical Care and Emergency Medicine","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84077877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of Cervical Immobilization in Multiple Trauma Patients","authors":"García S Cacho, Otero D Peña, Mutiloa M Eguillor","doi":"10.23937/2474-3674/1510061","DOIUrl":"https://doi.org/10.23937/2474-3674/1510061","url":null,"abstract":"Introduction: Immobilization is one of the most used procedures to prevent spinal cord injury in multiple trauma patients in prehospital setting. However, its protocolary use has historical principles rather than a scientific origin. Although this technique restricts the movement of the injured spine, there is no evidence supporting its use in all patients suffering from trauma. Objective: To contrast the effectiveness of immobilization in multiple trauma patients. Methodology: A bibliographic narrative review was carried out in databases such as PubMed, CINAHL Complete, ScienceDirect, Cochrane Plus and LILACS. Results: A total of 12 articles were obtained that met the inclusion and exclusion criteria established and answered the proposed objective. Discussion: The current literature does not clarify universal criteria about when patients should be immobilized. In addition, the great amount of harmful effects that can cause this technique to the patient are increasingly manifested. Conclusions: It is necessary to carry out more studies that provide scientific evidence of quality to know the effectiveness of cervical immobilization in multiple trauma patients, because this is still something uncertain.","PeriodicalId":13937,"journal":{"name":"International Journal of Critical Care and Emergency Medicine","volume":"125 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89881971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preparing Residents for Emergent Vascular Access: The Comparative Effectiveness of Central Venous and Intraosseous Catheter Simulation-Based Training","authors":"Schwab Kristin, Friedman Jodi, E LazarusMichael, P WilliamsJason","doi":"10.23937/2474-3674/1510069","DOIUrl":"https://doi.org/10.23937/2474-3674/1510069","url":null,"abstract":"Resident physicians are often required to perform central venous catheter (CVC) or intraosseous catheter (IO) placement when supervision is not readily available. We assessed whether brief CVC and IO simulationbased training increases resident knowledge and comfort performing these procedures unsupervised. Residents were assigned to either a 60-minute CVC training or a control group that received no training; they were also assigned to either a 30-minute IO training or a control group. Both trainings improved resident comfort performing the respective procedures (47% CVC intervention group vs. 26% CVC control group, p = 0.051; 47% IO intervention group vs. 16% IO control group, p = 0.006). There was also a statistically-significant summative effect of receiving both trainings, as 75% of the residents who received both trainings reported comfort obtaining unsupervised emergent vascular access. This suggests that residencies should include not only CVC, but also IO, simulation-based training sessions to prepare residents for emergency situations.","PeriodicalId":13937,"journal":{"name":"International Journal of Critical Care and Emergency Medicine","volume":"26 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72593666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is it Always Necessary to Take Blood Cultures before Starting Antibiotics in the Emergency Department? A Review of Usefulness of Blood Cultures in Community-Acquired Pneumonia, Cellulitis, Urinary Tract Infection and Pyelonephritis","authors":"Jun Koh Nan, Yu Quek Hui, F. Lateef","doi":"10.23937/2474-3674/1510062","DOIUrl":"https://doi.org/10.23937/2474-3674/1510062","url":null,"abstract":"Routine blood cultures are commonly taken in patients who present to the Emergency Department (ED) with suspicion of infection. This is also in conjunction with treatment guidelines for severe community-acquired pneumonia, acute meningitis and bacteraemia, etc. The above practice has become a major area of resource utilisation, despite many studies showing poor yield of these cultures. The poor yield of blood cultures is financially costly for patients, and even more so for hospitals. Hidden costs such as wastage of resources, additional working hours for healthcare staff and increased needle stick injuries are a huge burden to hospitals. In addition, contamination (or false-positive blood culture results) has been shown to lead to increased length of stay and total hospital charges. This review questions the efficacy of routine blood cultures taken in the emergency department, in the context of community-acquired pneumonia, cellulitis, urinary tract infection and pyelonephritis. The results of the review showed that blood cultures for community acquired pneumonia, simple and complicated cellulitis as well as simple acute urinary tract infections are not recommended as they do not hold much significant clinical impact on the antibiotic regimen and there is no need for them to be taken prior to the administration of antibiotics. Blood cultures should be taken in patients with severe signs of systemic infection, hospital-acquired pneumonia, complicated cellulitis and pyelonephritis because it is possible for blood cultures to have a bearing on the clinical management. ISSN: 2474-3674 DOI: 10.23937/2474-3674/1510062 • Page 2 of 5 • Jun et al. Int J Crit Care Emerg Med 2019, 5:062 patients with severe illness as there is a higher chance that pathogens not covered by empiric therapy will be found and hence influence antibiotic regimens [1]. A study by Makam, et al. looked at the trend of blood cultures collected in patients with CAP and found a relative increase of 73.4% in 2002 and 2010, whereas cultures obtained for urinary tract infection remained relatively stable [8]. One reason provided for the increase follows from the mandate by JCAHO and The Centres for Medicare and Medicaid guidelines on quality measures that emphasized performing blood cultures before administering antibiotics in the ED [10,11]. This prompted doctors to reflexively order cultures for patients with CAP for whom antibiotics are expected. Makam, et al. concluded that appropriate blood cultures use should be reserved only for the sickest patients when the results could reduce harm, limit hospital stay and lower costs [8]. Other literature suggest that blood cultures rarely altered the management of CAP. Ramanujam, et al. in 2006 revealed positive blood cultures for bacteraemia in 4.5% of the patients with 1.3% warranting a change in antibiotic regimen because of deterioration of clinical status and not due to blood culture results [9]. This is similar to another article in 2007","PeriodicalId":13937,"journal":{"name":"International Journal of Critical Care and Emergency Medicine","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80016981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Iatrogenic Related to the Knowledge Deficit of Patient Safety in the Care: A Descriptive Analysis","authors":"R. Miranda, Lima Matheus Dullius, nascimento Valter Aragão do, Sarti Elaine Cristina Fernandes Baez","doi":"10.23937/2474-3674/1510081","DOIUrl":"https://doi.org/10.23937/2474-3674/1510081","url":null,"abstract":"Objective: This study aims to portray the patient’s safety interfaces in intensive care in a Brazilian public health institution and the presence of iatrogenies. Design: This study has an exploratory descriptive approach of qualitative condition; the research was carried out from 2009 to 2010. Setting: The study was carried out in six units, which require intensive care in health, of a large public hospital in the state of Pernambuco. Subject: Of the 163 participants in the qualitative study, thirty-one were nurses, a hundred and ten were nursing technicians and twenty-two were nursing assistants. Measurements and main results: This study also highlights the performance deficit in relation to the protocol used in the diet, that 91 (55.8%) health professionals do not perform intensive therapy in diet administration according to the protocols. Interventions: Updates and training programs are being developed intensively in the hospital with the purpose of promoting the best functional performance of the employee and maintaining the institution's sustainability in the health market. Conclusion: In intensive care in Brazil, it is still emphasized that educating the health professional is fundamental to increase the quality of care to the critical patient and, thus, to reduce the negative indicators of iatrogenies.","PeriodicalId":13937,"journal":{"name":"International Journal of Critical Care and Emergency Medicine","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81234207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Prospective Study on Severe Hypotension in Critically Ill Patients Sedated with Propofol","authors":"Sherif Abdelmonem, T. Helmy, Iman El Sayed, S. Ghazal","doi":"10.23937/2474-3674/1510078","DOIUrl":"https://doi.org/10.23937/2474-3674/1510078","url":null,"abstract":"","PeriodicalId":13937,"journal":{"name":"International Journal of Critical Care and Emergency Medicine","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82805485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pneumococcal Sepsis as a Cause of Massive Splenic Infarction in Patient with Unknown Celiac Disease","authors":"A. Graziani, F. Cappa, E. Fiorini, P. Casalini, F. Albertini","doi":"10.23937/2474-3674/1510079","DOIUrl":"https://doi.org/10.23937/2474-3674/1510079","url":null,"abstract":"stended and diffusely tender without guarding or re-bound. Initial laboratory evaluation demonstrated: White Blood Cells (WBC) 37210 × 10 9 /liter; hemoglobin (Hb) 11.5 g/dL; platelets (PLT) 12 × 10 9 /liter; creatinine, 1.53 mg/dL; total bilirubin 1.3 mg/dL; direct bilirubin, 0.9 mg/dL; ALT 75 U/L; INR 1.39; fibrinogen 232 mg/ dl, activated partial thromboplastin (aPTT) 37 sec (ra-tio 1.39); C-reactive protein (CRP) 272 mg/L (normal < 5 mg/L), lactate 6.2 mmol/l. The chest X-ray and the abdomen X-ray were unremarkable.","PeriodicalId":13937,"journal":{"name":"International Journal of Critical Care and Emergency Medicine","volume":"274 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80008541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Outcome of Undisplaced Femoral Neck Fracture in Elderly","authors":"A. Faraj, P. Hussain, K. Velusamy","doi":"10.23937/2474-3674/1510080","DOIUrl":"https://doi.org/10.23937/2474-3674/1510080","url":null,"abstract":"The management of Garden type 1 and 2 undisplaced proximal femoral intracapsular fracture in elderly patients is controversial. Many options including arthroplasty and fixation have been suggested based on patient's age and cognitive function. We have retrospectively reviewed 85 elderly patients with undisplaced femoral neck fracture. The mean age of the cohort was 81 years. 52 patients were treated with cemented hemi-arthroplasty, 19 with dynamic hip screw fixation, 10 had cannulated screw fixation, total hip replacement in 3, and conservative management for one patient. We reviewed the cohort for a mean period of 3 years and we looked into their general complications, local complications related to the hip and mortality. and 32% with Dynamic Hip screw), had good outcome. All the patients treated using total hip replacement, the patient treated conservatively, also had good outcome and 56% of the fixation group had poor outcome. The good results of hemiarthroplasty were predictable for patients with ASA III (27), and ASA IV (11). Patients chosen to have THR had better ASA grade than the remaining. In general the outcome in arthroplasty group was superior to the DHS and cannulated screws. Conclusion: From the study it is clearly evident that arthroplasty provides better outcome for elderly patients with undispalced femoral neck fracture especially with poor cognitive function.","PeriodicalId":13937,"journal":{"name":"International Journal of Critical Care and Emergency Medicine","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81457912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}